Dive Brief:
- CMS announced Wednesday proposed updates to payment rates and policies in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.
- The changes, based on feedback from providers and patient advocates, are aimed at improving the care of Medicare patients by better supporting their healthcare providers, CMS said.
- The proposed rule (764 pages) would increase OPPS payments by an estimated 1.6% and ASC payments by 1.2% in 2017.
Dive Insight:
The proposed updates will "better support physicians in providing beneficiaries with the right care at the right time," according to acting CMS Administrator Andy Slavitt.
The rule touches on several different areas:
Pain management: In response to concerns that patient survey questions in the Hospital Value-Based Purchasing program may overly influence prescribing practices, CMS proposes to remove the pain management dimension from the program to avoid any form of pressure.
Focusing payments away from setting: CMS is looking to implement section 603 of the Bipartisan Budget Act of 2015 to help to ensure the Medicare program doesn't pay more for care based on the setting in which it is provided. This would end the current system of paying more for the same services in a hospital outpatient department vs. a physician’s office, which has prompted hospitals to acquire physician offices to bill at the higher rates--increasing costs for Medicare and increasing the cost-sharing liability for beneficiaries.
Improving care through technology: CMS wants to increase flexibility for hospitals participating in the Medicare EHR Incentive Program, with changes including a switch to a 90-day EHR reporting period rather than a full calendar year.
Emphasizing outcomes and experiences that matter to patients: CMS aims to add new quality measures to the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program, as well as enhance the outcome requirements for organ transplant programs.
CMS is accepting comments on the proposed rule until September 6.
One response came quickly after the late release on Wednesday. Tom Nickels, EVP, governement relations and public policy at the American Hospital Association stated, "We are extremely dismayed by the short-sighted policies in today’s proposed rule," adding, "Hospitals and health systems and more than half of the House and the Senate requested that CMS provide reasonable flexibility when implementing Section 603 of the Balanced Budget Act of 2015 in order to ensure that patients have continued access to hospital care. Instead, the agency is actually proposing to provide no funding support for outpatient departments for the services they provide to patients."