STAT readers respond to First Opinion essays on site-neutral payments, free medical school tuition, and more

“Former HHS secretaries: Congress should adopt site-neutral payments for health care,” by Alex Azar and Kathleen G. Sebelius

As a practicing oncologist, I wholeheartedly agree with the former HHS secretaries’ call to expand site-neutral payment policy. It is a commonsense reform, independent of one’s political leanings.

Regardless of party, policymakers can agree that giving patients the care they need close to home — at an affordable price — is critical. This year, more than 2 million Americans are projected to receive a cancer diagnosis — an all-time record — so this must be a priority.

As the authors rightly point out, costs for chemotherapy, mammograms, colonoscopies, and other drugs are significantly higher in hospital settings than in doctors’ offices. These payment differentials between hospital outpatient departments (HOPDs) and independent community practices are driving up costs and limiting patient access.

Discrepancies in reimbursement rates have driven large hospitals to acquire physician practices, inflating costs for Medicare, private insurers, patients, and employers. Case in point: hospitals acquired more than 44,000 independent practices from 2019 to 2024. As a result, more than half of today’s physicians are now employed by a hospital or health system.

While site-neutral payment reform has always been a bipartisan issue, previous reforms didn’t go far enough in transforming or resolving payment disparities. Congressional reform efforts in 2015 only applied to newly built HOPDs, which only account for 2.3% of Medicare outpatient spending, allowing older HOPDs to continue benefiting from a higher payment rate. It is time to fully address this problem once and for all.

Late last year, the House of Representatives passed the Lower Costs, More Transparency Act (H.R. 5378) by a strong, bipartisan vote of 320-71. This bill would require site-neutral payments for drug administration services, lowering out-of-pocket costs for cancer patients and reducing incentives for consolidation. I thank former HHS secretaries Alex Azar and Kathleen Sebelius for highlighting the need to standardize payment rates across sites of services and join you in calling for immediate action.

— Dr. Mark T. Fleming, chair of The US Oncology Network’s National Policy Board

“H5N1 bird flu in U.S. cattle: A wake-up call to action,” by Luciana Borio and Phil Krause

A statement was made in this article, “H5N1 will not be detected by the typical rapid flu antigen tests that are administered in emergency rooms and many doctors’ offices.” The QuidelOrtho QuickVue and Sofia Flu tests do, in fact, detect H5N1.

— Allison Leone, QuidelOrtho Corporation

“Free med school tuition won’t solve the shortage of primary care physicians,” by Ezekiel J. Emanuel and Matthew Guido

A point that economists of both sides agree on: that the American Medical Association is a lobbying group that keeps doctor wages artificially high. It does so by keeping the supply of doctors low. Most countries have med school education begin right after high school and last five years. America requires an undergrad degree first. This is 4 + 3 years for a medical degree. Requirement of an expensive license adds more burden on the doctor. And then, bringing in doctors from abroad is made ridiculously hard. These are just a few of the sneaky ways that becoming a doctor is made arduous. It keeps the number of doctors low. The scarcity pushes their wages high.

— Deepa R

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This discussion has been going on for years.

Family practice and the other primary care physicians remain the step child of other specialists. Every with training and experience, financial credentialing slowly restricted my practice.

Clearly having a system that pays more for procedures than for management of multiple medical health conditions and the mental health will continue to limit the growth of Family Practice and primary care providers.

— Manuel Salinas

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The authors enumerate a number of the important reasons why there are and will continue to be fewer family physicians in this country. For all those medical students in the top ranks of their graduating classes, I would add that their faculty and career mentors’ influence come at a time when students are at their most impressionable. Those faculty are overwhelmingly single discipline specialists and sub specialists, sometimes called super specialists.

There’s nothing wrong with being special — except when the message is consistently and incessantly communicated in so many words and deeds that family medicine and much of the rest of primary care is reserved for the less capable of their classmates.

Until medical school faculty are drawn from among the best and brightest, the high-octane minds and social concerns that primary care physicians must embody will continue to be unmatched.

— Barry Farkas

“An FDA pathway can accelerate innovation for Duchenne muscular dystrophy,” by Jennifer Handt

I am moved by this article on Duchenne muscular dystrophy. We have made dramatic advances with genome sequencing for very rare diseases and must continue on this path to improve patient outcomes and quality of life for kids like Charlie. Let’s keep pushing until we crack the code. I strongly urge the FDA to use the accelerated approval program for new treatments. We may also learn more by using AI in healthcare. It takes great minds with a lot of heart to find a cure for diseases like Duchenne. Thank you!

— Ken Checicki