To further commitment to and address responsibility for increasing access and value, the ACC, under the guidance of the Health Affairs Committee, has put forth principles pertaining to site neutral payments within Medicare:

• Changes to Medicare payment should prioritize patient access, quality and value of care.
• Approaches to remove unnecessary and/or unexpected cost to patients and the health care system, including equity across outpatient ambulatory settings, should be discussed.
• Significant changes to address payment disparities between sites of service must be phased in over time to safeguard the stability of the health care system.
• Proposals must consider the financial impact of changes on the stability of the health care system, particularly those providing care to underserved populations.
• Site of service payment policies must be aligned with programmatic and systemic changes to avoid unnecessary complexity and promote the successful transition to a value-based payment system.
• Any payment differences across sites should be related to documented differences in the resources needed to ensure patient access and high-quality care.
• Medicare payments for all sites of care should account for costs related to emergency capacity, compliance with regulatory requirements, geographic differences, quality improvement activities, higher need populations, or other factors relevant to a site of service.