The catalyst: CMS's CY2026 OPPS final rule (effective January 1) extends "site-neutral" payment to drug-administration services at off-campus hospital outpatient departments, cutting those payments to the Physician Fee Schedule-equivalent rate — roughly 40% of what hospitals previously billed Medicare for the identical infusion given across town at a doctor's office. CMS projects ~$290 million in 2026 savings alone, and Congress's bipartisan "Same Care, Lower Cost Act" would go much further, forcing HOPD-wide parity and mandatory separate NPI billing for off-campus sites by 2028. The mechanism is simple: Medicare currently pays a facility fee premium — often 2-3x the physician-office rate — for the exact same visit, injection, or scan, purely because a hospital bought the clinic and slapped its name on the building. Close that gap and you delete a recurring, structural revenue stream that hospital-owned outpatient networks have spent two decades building via acquisition.