- Hospitals are applauding a decision by CMS to repay some hospitals that saw cuts to certain payments related to their off-campus hospital clinics for 2019, following a legal win in a suit against the agency. The cuts were part of a move to pay the same rates to hospital-owned facilities as independent physician groups, known as site-neutral payments.
- Still, CMS is appealing the federal court judge's ruling against CMS, according to a filing submitted Thursday to the Federal District Court for the District of Columbia.
- The American Hospital Association is calling on CMS to abandon similar cuts in 2020, characterizing them as "illegal" following the court ruling against the cuts.
In a bid to curb costs and stem further consolidation, CMS implemented rules that equalize payments to independent physician groups and hospital-owned outpatient facilities.
The move received intense pushback from hospital providers, and the American Hospital Association filed suit over the cuts. In September, a federal judge ruled in favor of the hospital group.
Over the next few months, CMS now says it will automatically reprocess claims paid at the reduced rate. It's unclear how much hospitals are owed by CMS or how many hospitals can expect repayments.
Still, the showdown between the hospital lobby and CMS is likely to continue as the federal regulator said it will continue its site-neutral policy for 2020.
CMS said the district court vacated the volume control policy for calendar year 2019 but it will move forward with implementation for 2020. "We do not believe it is appropriate at this time to make a change to the second year of the two year phase-in of the clinic visit policy," a CMS spokesperson said in a statement to Healthcare Dive.
AHA has asked the judge to apply her earlier ruling to CMS 2020 cuts as well, arguing those violate the court order, according to a filing from Nov. 11.
CMS gave notice Thursday that it will appeal the ruling.
Policy experts say the difference in payments between similar facilities — the only difference being whether they're owned by a hospital — is a major problem.
"For instance, at an off-campus [hospital outpatient department] built before November 2015, Medicare paid about $158 for a clinic visit for an established patient in 2017, whereas it paid about $74 for a similar visit in a physician’s office," according to a report from the USC Brookings Schaeffer Initiative for Health Policy.
CMS estimated that taxpayers and Medicare would save $800 million in 2020 thanks to the site-neutral policy.