Controversial CMS proposal continues to divide physicians, hospitals


The controversy goes on over a government proposal to no longer pay for services at hospital outpatient departments at a higher rate than physicians’ offices, with physicians and hospitals continuing to line up on opposite sides of the fence.

Organizations that represent physicians continue to applaud the Centers for Medicare & Medicaid Services (CMS), while hospital organizations are critical. As FiercePracticeManagement reported last week, the American Medical Association and American Hospital Association both took opposing views. 

The Alliance for Site Neutral Payment Reform and one of its members, the U.S. Oncology Network, both released statements supporting CMS’ new policy contained in its proposed rule for the 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Payment System, which was released last week. On the other hand, America’s Essential Hospitals, an association that represents hospitals and health systems, said in an announcement that the proposal threatens to reduce access to badly needed healthcare services in the country’s most underserved communities.

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The Alliance for Site Neutral Payment Reform, which also includes the Academy for Family Physicians (AAFP) and American College of Physicians, said CMS’ proposal ensures off-campus provider-based departments will not be paid under OPPS beginning January 1, 2017 as required by Section 603 of the Bipartisan Budget Act of 2015.

“The Bipartisan Budget Act of 2015 marked a monumental step in finally ensuring fiscally responsible, common-sense payment parity across sites of service,” said Robert Wergin, M.D., chair of the AAFP board of directors, said in the Alliance announcement. “We applaud CMS for interpreting the legislation in a way that stays true to the spirit of the law, and Congress’s original intent when passing it. However, policymakers should go a step further and ensure this common sense approach applies to all off campus outpatient facilities.”

The proposed rule would exempt certain off-campus emergency departments that could continue to bill for services under the typically higher OPPS.

Debra Patt, M.D., medical director for the U.S. Oncology Network, which represents community-based oncology physicians, called on CMS to extend site-neutral payment provisions to all off-campus outpatient facilities, whether new or existing. The group said there has been a slow shift of cancer care from lower cost physician office settings to more expensive hospital outpatient settings, with more than 30 percent of oncology care shifting in the last decade.

But America’s Essential Hospitals said the proposal for new off-campus hospital outpatient department fails to recognize the challenge of establishing and sustaining healthcare facilities for vulnerable populations. “The agency’s decision to not only limit flexibility, but to withhold hospital payments altogether, will perpetuate health care deserts--urban and rural pockets of poor access to care that persist in all 50 states and the District of Columbia,” the group said. “Hospital systems that otherwise would seek to enhance access by establishing new clinics in underserved areas will not do so, as this damaging payment policy makes new outpatient centers economically unsustainable.”

- read the Alliance announcement
- find the America’s Essential Hospitals announcement
- check out the proposed rule

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