A national study found that larger, more complex health systems were not associated with better quality than independent hospitals and physician practices. Hospitals argue that higher outpatient reimbursement rates are necessary to support emergency departments, trauma centers, teaching programs and other essential services. Yet, evidence suggests those concerns are overstated for routine outpatient care that can safely be delivered in physician offices. Because many commercial insurers benchmark their reimbursement rates to Medicare, site-neutral payments could also help moderate healthcare costs throughout the private insurance market. Medicare should pay for the care patients receive, not the ownership structure of the provider delivering it.