Hospitals receive 3.6% inflation update

The final Medicare outpatient payment rule includes a 3.6% annual inflation update for hospital outpatient departments (HOPDs).

In 2009, hospitals that report seven outpatient quality measures will receive the full inflation update. Hospitals that don't submit data will receive a 1.6% update. The reduction will not apply to payments for separately payable pass-through drugs and devices, separately payable drugs and biologicals, separately payable therapeutic radiopharmaceuticals, brachytherapy sources that are paid at charges adjusted to cost, and services assigned to new technology ambulatory payment classifications (APCs). The final rule outlines a voluntary validation process that hospitals can use to test their quality data during calendar year (CY) 2009.

The final rule emphasizes that the Centers for Medicare & Medicaid Services (CMS) will develop and implement a policy that will not pay hospitals for care related to illness or injuries acquired by the patient during a hospital outpatient visit. Such a policy, which CMS expects to propose in the future, will be known as hospital outpatient health care-associated conditions (HOP-HACs). It will make adjustments to outpatient prospective payment system (OPPS) payments, similar to those in the inpatient setting. CMS Acting Administrator Kerry Weems said, "In this final rule, we are continuing to pay appropriately for care while working with health care providers as we look for ways to make sure beneficiaries who come in for treatment of one complaint don't leave with two as a result of adverse events during their outpatient visits."

The final rule adopts four new quality measures for imaging efficiency. CMS will continue to consider 18 additional quality measures, including screening for fall risk, that were identified in the CY 2009 proposed rule.

Under the final rule, the amount beneficiaries will pay for outpatient services will continue to decline based on a formula that is designed to provide a gradual transition to 20% coinsurance for all APCs. CMS estimates that nearly 25% of all types of services furnished in hospital outpatient departments (HOPDs) will be subject to the 20% coinsurance rate in CY 2009.