CMS proposes changes to outpatient and ambulatory surgery payment rates

CMS

The Centers for Medicare & Medicaid Services yesterday proposed changes to policies and payment rates under the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

The proposed rule, published in the Federal Register, includes a policy change that would remove patient pain assessment survey questions from figuring into Medicare reimbursements.

CMS made the policy change in response to critics who said physicians were pressured to prescribe opioid painkillers because patients are asked about their pain levels on satisfaction surveys that help determine federal reimbursement payments. That pressure helped to contribute to the country’s current opioid epidemic, critics say.

While there is no empirical evidence of the effect on physicians’ prescribing habits, CMS said in an announcement it was proposing to remove the pain management section from the patient satisfaction surveys to eliminate any potential financial pressure clinicians may feel to overprescribe pain medications.

CMS estimates that the updates in the proposed rule would increase OPPS payments by 1.6 percent and ASC payments by 1.2 percent in 2017. Other proposed changes from CMS include:

Leveling the playing field for services provided in physician offices. The proposed rule would ensure that certain items and services provided by some hospital off-campus outpatient departments would no longer be paid under OPPS. Currently, Medicare pays a higher rate for certain items and services provided in a hospital outpatient department rather than a physician’s office, CMS said. The payment differential has encouraged hospitals to acquire physician offices in order to receive the higher rates, which has been a long-standing concern of Congress and other groups.

Improving patient care through technology. As it streamlined electronic health record reporting requirement for physicians under the proposed rule to implement the Medicare Access and CHIP Reauthorization Act, CMS proposed changes for hospitals and critical access hospitals participating in the Medicare EHR Incentive Program. Find out more in this report by FierceHealthIT.

Adding new quality measures focused on improving patient outcomes and experience of care.

CMS will accept comments on the proposed rule through September 6.

- check out the CMS announcement
- read the proposed rule (.pdf)
- here's a CMS fact sheet