CMS increases hospital outpatient payments

Starting in the new year, hospitals will see a 1.8 percent payment increase for outpatient services, as the Centers for Medicare & Medicaid Services yesterday finalized the Hospital Outpatient Prospective Payment System (OPPS) to become effective Jan. 1, 2013. Four thousand hospitals could therefore see up to $48.1 billion in total OPPS payments in the next calendar year.

CMS came to the 1.8 percent increase decision, basing it on inpatient market basket percentage of 2.6 percent for inpatient services under inpatient PPS, minus the multi-factor adjustment of 0.7 percent for the economy's productivity and minus 0.1 percent for an adjustment under the health reform law, the final rule states.

The final rule includes a significant policy change to OPPS payments, which CMS says, will better reflect average costs of services and aligns of IPPS. It bases relative payment weights on geometric mean costs rather than median costs, according to CMS.

Under the OPPS final rule, ambulatory surgical centers also will see a 0.6 percent increase, leading to approximately $4.07 billion in total payments next year.

CMS also issued a separate final rule to increase Medicare payments by 3 percent to 7 percent to primary care physicians, encouraging them to coordinate care with hospitals and skilled nursing facilities--that is, if Congress averts the required 26.5 percent across-the-board reduction in Medicare's physician fee schedule.

The physician fee rule also recognizes the role of nonphysician providers, allowing Medicare payments for certified registered nurse anesthetists for all services they are permitted to perform under state law and scope of practice. The rule also allows Medicare to pay for portable X-rays ordered by nurse practitioners, physician assistants and other nonphysician practitioners, CMS states.

For more information:
- see OPPS final rule (.pdf) and announcement
- here's the physician fee final rule (.pdf) and announcement

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