Hospitals win 1.9% Medicare payment bump in CMS OPPS final rule

The hospital outpatient prospective payment system (OPPS) will increase payment rates by 1.9 percent, effective Jan. 1, 2012, according to the Centers for Medicare & Medicaid Services (CMS) final rule issued Tuesday. CMS estimates that payments will total $41.1 billion for 4,000 hospitals, including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children's hospitals, and cancer hospitals under the OPPS rule. Cancer hospitals specifically will see increased payments of 11.3 percent (approximately $71 million), according to a CMS press release. CMS also estimates that 5,000 ambulatory service centers will see a 1.6 percent increase (total of $3.5 billion) in payments.

"This is marginally good news, but it is certainly not a game changer by any stretch of the imagination," said Arthur Henderson, an analyst at Jefferies & Co. Inc. in Nashville, Tenn., according to Bloomberg. For example, operator Tenet Healthcare Corp. in Dallas might benefit from the outpatient payment increases, as it acquired 24 outpatient centers last year. "This is a portion of Tenet's business that they're interested in growing," Henderson said. "Since they've expressed a desire to continue to make acquisitions there, it will be marginally helpful."

In addition, under the final rule, CMS announced revised program requirements for the hospital value-based purchasing program that will affect inpatient payments, effective Oct. 1, 2012. CMS added one clinical process measure to guard against infections due to urinary catheters and established the weighting, performance periods, and performance standards for the clinical process, patient experience, and outcomes measures for fiscal year 2014. Notably absent from the program requirements were hospital-acquired condition measures, Agency for Healthcare Research and Quality composite measures, or the efficiency measure.

American Hospital Association Executive Vice President Rick Pollack responded, "We are pleased that CMS responded to the concerns of hospitals. Congress had established a specific process for CMS to follow for the VBP program. ... We commend CMS for recognizing that this process is important to protect hospitals and their patients from flawed measures."

For more information:
- read the CMS press release
- check out the CMS final rule (.pdf)
- read the Bloomberg article
- read the AHA News Now brief

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