EP469 (Part 2): The Impact on Plan Sponsors of Medicare Site-Neutral Payments and HSA Reforms, With James Gelfand, JD

Mar 27, 2025

30:36

Health Policy Primary Care Fitness & Exercise

Episode Description

In Part 2 of Episode 469, host Stacey Richter discusses the implications of Medicare site-neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC). The episode details how plan sponsors should adapt to Medicare's site-neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility fees and markups. Gelfand provides insights into how HSA reforms currently in Congress could expand the scope of preventive care covered before deductibles are met, benefitting both employers and employees. The conversation also touches on the challenges high-deductible health plans pose and the potential benefits of codifying recent IRS guidance to allow greater flexibility in pre-deductible coverage. The discussion underscores the importance of plan sponsors staying ahead of Medicare policies to avoid higher costs.

WHAT YOU'LL LEARN

✅ What Medicare site-neutral payment policy actually means, and why it's designed to stop hospitals from charging a facility fee markup simply because a service happens to be delivered on a hospital campus rather than in a physician's office

✅ Why the site-neutral push is starting narrow — and what action steps plan sponsors should be taking now to align their own contracts with where Medicare policy is headed, rather than waiting for it to catch up to them

✅ What options plan sponsors have in highly consolidated markets where there may be no non-hospital-owned alternative to steer members toward

✅ How the proposed HSA reform bill could change pre-deductible coverage — expanding what preventive care can be covered before a member hits their deductible

✅ Why the thinking behind HSA usage has shifted since their inception, and why codifying recent IRS guidance on pre-deductible coverage would give employers more flexibility without abandoning the high-deductible plan structure entirely

WHY THIS MATTERS

Site-neutral payment reform and HSA modernization are both, in Gelfand's framing, catch-up plays — policy trying to close gaps that self-funded plan sponsors have been absorbing the cost of for years. The plan sponsors who benefit most from these changes will be the ones who understand the mechanics well enough to align their own contracting and plan design ahead of the regulatory curve, rather than reacting to it after the fact.

MENTIONED IN THIS EPISODE

EP471 with Christine Hale, MD, MBA: Apple Podcasts | Spotify | Other Apps

EP371 with Erik Davis and Autumn Yongchu: Apple Podcasts | Spotify | Other Apps

EP448 (Part 1) with Shawn Gremminger: Apple Podcasts | Spotify | Other Apps

INBW41 with Stacey Richter: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel