Medicare patients who receive care in a hospital outpatient department clinic are more likely to be poor, previously hospitalized and have severe chronic conditions than those treated in an ambulatory surgical center, according to a study by KNG Health Consulting released April 4 by the American Hospital Association. Medicare already reimburses hospitals – which have more comprehensive licensing, accreditation and regulatory requirements than do freestanding physician offices and ASCs – less than the cost of providing care. For example, Medicare margins for outpatient services were negative 12.8 percent in fiscal year 2017, while overall Medicare margins were a record-low negative 9.9 percent. Compounding these shortfalls with proposals that treat HOPDs and ASCs the same could threaten access to care for the most vulnerable patients and communities, AHA said.