Site-neutral payment reforms: Implications for cost, competition and rural health care
Abstract
Site-neutral payment reforms offer a strategic approach to standardise reimbursement rates across care settings, aiming to reduce inefficiencies and enhance fiscal accountability within the US healthcare system. While these reforms target excessive payments to hospital outpatient departments (HOPDs) and promise substantial savings for Medicare and private insurers, they present critical operational and financial challenges for rural healthcare providers. Rural hospitals, already constrained by limited resources and narrow margins, face heightened risks of service reductions and closures under uniform payment models. This paper examines the unintended consequences of site-neutral payment policies on rural healthcare delivery, emphasising how these reforms, without appropriate safeguards, may accelerate hospital-physician consolidation, inflate costs and erode patient choice, particularly in underserved regions. Drawing on empirical data and policy analysis, the study highlights the systemic vulnerabilities exposed by current reform efforts. To address these challenges, we propose a management-focused policy framework that balances cost containment with rural healthcare sustainability. Major recommendations include phased implementation strategies tailored to rural contexts, enhanced federal reimbursement support, preservation incentives for independent physician practices and strengthened antitrust oversight to mitigate consolidation pressures. For healthcare executives, policymakers and system managers, this research underscores the necessity of integrating adaptive regulatory mechanisms and targeted financial interventions to ensure that efficiency-driven reforms do not compromise equitable access to care. A proactive, rural-conscious management strategy is essential to align national payment reforms with the long-term viability and competitiveness of rural healthcare systems. This article is also included in The Business & Management Collection which can be accessed at https:// hstalks.com/business/.
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Author's Biography
James Dockins Dr James Dockins is a professor of management in the healthcare leadership programme at Rockhurst University. He teaches classes in health systems, quality management, health policy, leadership and international business. He has over 30 years of experience in the healthcare industry as a senior hospital and health plan executive in the United States and has also served in leadership roles in international hospitals in India, Saudi Arabia and Mauritius. While attending the University of Memphis, he obtained an EdD degree and earlier received an MBA from Lincoln University. He earned his undergraduate health sciences degree from the University of Missouri-Columbia. His research interests include healthcare quality, access to health care, health policy, patient satisfaction, pricing transparency and employee satisfaction. He is a life fellow of the American College of Healthcare Executives.
Dave Lingerfelt started his professional career at the Cerner Corporation in 2002 as a technical support engineer. He moved on to manage the technical training division and then the social business (Web 2.0) implementation team, working to establish a social business presence for Cerner. In his last 2 years at Cerner he worked in the remote hosting division. He was responsible for implementing and supporting large-scale health systems as they adopted new technology and upgraded existing platforms. He holds a BS in management information systems and computer science from Kansas State University. He earned his MBA with emphasis in healthcare leadership from Park University. He currently works at Rockhurst University in the Helzberg School of Management as the Director/Professor of Healthcare and Data Science. He is also the Co-Founder of ITdoc Consulting.
Citation
Dockins, James and Lingerfelt, Dave (2025, December 1). Site-neutral payment reforms: Implications for cost, competition and rural health care. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 10, Issue 2. https://doi.org/10.69554/FHZG7790.
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