Trump administration details hospital spending plans in FY21 proposed budget

In what could be a 2021 preview if Republicans take control of Congress and retain the White House, the Trump administration included a range of sweeping healthcare policy proposals targeting hospitals when it released its proposed budget Feb. 12.

Although the current Congress may ignore the budget, the proposals could come back as last-minute funding sources for big-budget packages or as part of major healthcare policy changes in the next Congress.

The budget includes policies that would directly affect hospital revenue in widely varying ways, including:

* Limiting uncompensated-care bad debt payment increases to the consumer price index for all urban consumers

$87.9 billion in savings over 10 years

* Requiring site-neutral payments between on-campus hospital outpatient departments (HOPDs) and physician offices for services, such as clinic visits, commonly provided in non-hospital settings

$117 billion in savings

* Eliminating Medicare bad debt payments for disproportionate share eligible hospitals, exempting rural hospitals

$33.6 billion in savings

* Requiring all off-campus HOPDs to be paid under the Physician Fee Schedule

$47.2 billion in savings

* Allowing increased Medicaid copayments for nonemergency use of emergency departments

$1.8 billion in savings