Discharge Planning Advisor: Final outpatient PPS rule increases spending

The 1,000-page final outpatient prospective payment system (OPPS) rule, which takes effect this month, provides the congressionally mandated inflationary update and increases overall spending, but still pays hospitals only 83 cents for every dollar spent on outpatient care, the Chicago-based American Hospital Association (AHA) points out.

The rule gives the mandated 3.5% increase, but the net effect of all provisions in the rule is a 3.1% increase from last year for urban hospitals and a 6.2% increase for rural hospitals, according to a report in the on-line service AHA News Now.

The rule does not include a pro-rata reduction in pass-through payments for certain new and high-cost devices, drugs, and biologicals. It lowers the outlier threshold from 3.5 to 2.75 times the ambulatory payment classification amount, enabling hospitals to reach the outlier threshold sooner. However, outlier reimbursement will drop from 50% to 45% of costs above the threshold amount.