HOPDs rate updated, tied to quality measures

Hospitals to receive about 3% payment increase

Under a proposed regulation, the Centers for Medicare & Medicaid Services (CMS) would require hospital outpatient department (HOPD) payment rate updates to be tied to inpatient quality measures provided by the hospital, beginning in 2007. Under the proposal, hospitals that don't submit the required quality data would see their HOPD rate updates reduced 2 percentage points.

For fiscal year 2008, CMS proposes that several quality measures be added, including the following from the Surgical Care Improvement Project (SCIP): venous thromboembolism (VTE) prophylaxis ordered for surgery patients, VTE prophylaxis within 24 hours pre-/post-surgery, and prophylactic antibiotic selection for surgical patients. CMS also proposes to move "as quickly as possible" to the use of additional quality measure that are specifically appropriate for hospital outpatient care, as such measures are developed, according to Mark B. McClellan, MD, PhD, CMS administrator, who held a media conference call on Aug. 8. McClellan also indicated that ambulatory surgery centers eventually will be required to provide quality data.

The proposed rule includes a 3.4% inflation update for HOPDs for 2007. After taking into account other factors that affect the level of payments, CMS estimates that hospitals will receive an overall average increase of 3% for HOPDs in 2007. [Editor's note: For further information on hospital outpatient prospective payment issues, contact Alberta Dwivedi, CMS. Phone: (410) 786-0378.]