CMS addresses outpatient payment disparities in final OPPS rules


The Centers for Medicare & Medicaid Services has finalized the new payment rates for the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System.

Altogether, the changes would increase the OPPS payments by 1.7 percent and ASC payments by 1.9 percent in 2017.

However, hospitals will lose out on some enhanced payments. The new OPPS rules exclude payments of certain outpatient services at inpatient levels at off-site facilities owned by hospitals.

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“This payment differential has provided an incentive for hospitals to acquire physician offices in order to receive the higher rates,” CMS said in an annoucement. “This acquisition trend and difference in payment has been highlighted as a long-standing issue of concern by Congress, the Medicare Payment Advisory Commission, and the Department of Health and Human Services Office of Inspector General.”

The agency said it had intended to address the issue when it issued the interim rules back last summer.

“We spoke to stakeholders across the outpatient community who care about the quality and value of care that Medicare patients receive,” said Sean Cavanaugh, CMS deputy administrator. “The policies finalized in today’s rule will not only improve the value of care provided to Medicare beneficiaries, but are also responsive to healthcare providers who are crucial to outpatient care.”

While so-called site-neutral payments have been largely supported by physician groups, they have been fiercely opposed by many in the hospital sector, although projections suggest they could save as much as $30 billion over the next decade. The Bipartisan Budget Act passed by Congress last year essentially eliminated the payment disparities between different sites.

In addition to issuing the final ASC and rules, CMS also issued an interim final rule regarding the Medicare Physician Fee Schedule that will address other payments received by off-campus hospital providers.

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