Hospitals disappointed with final payment rule
The final calendar year (CY) 2014 hospital outpatient and ambulatory surgery center (ASC) payment rule [CMS-1601-FC] indicates that the Centers for Medicare & Medicaid Services (CMS) "will move forward with sweeping changes that may hurt hospitals' ability to provide outpatient care," said Rick Pollack, executive vice president of the American Hospital Association (AHA). He said the AHA is "extremely disappointed."
Provisions in the final hospital Outpatient Prospective Payment System (OPPS) rule package the payment for multiple supporting items and services into a single payment for a primary service, similar to the way Medicare pays for hospital inpatient care, according to CMS. Supporting items and services that will be included in a single payment for a primary service to the hospital and not paid separately include the following:
- drugs and biologicals that function as supplies when used in a surgical procedure, including skin substitutes;
- drugs, biologicals, and radiopharmaceuticals that function as supplies when used in a diagnostic test or procedure;
- device removal procedures;
- certain clinical diagnostic laboratory services;
- certain procedures that are never done without a primary procedure (add-ons).
Also, CMS will finalize its comprehensive ambulatory payment classifications (APCs) to replace the existing device-dependent APCs, such as cardiac stents and defibrillators, but has delayed their implementation until Jan. 1, 2015.
Pollack said the AHA is glad that CMS won't be collapsing its codes for emergency department visits. However, he says, "we are very concerned that CMS is moving forward with consolidating all outpatient clinic visit codes into a single code representing a single level of payment. Hospitals that provide care for large numbers of complex patients will receive payment well below the cost of treating these patients."
Pollack said CMS might not have used accurate information in developing the policies. He also expressed concern "that hospitals will have neither the time nor the data to understand how these changes will affect their ability to provide patient services"
"In adopting these proposals, CMS has put hospitals in the difficult position of having only 35 days to implement significant changes in Medicare's policies, procedures, and payment formulas," he said.
Pollack also expressed disappointment that CMS is moving forward with enforcing its direct physician supervision policy. "Given the shortage of medical professionals, this policy may force small and rural hospitals and critical access hospitals to limit their hours of operation or cut services to comply with the provision, resulting in reduced access to outpatient care in communities across America," Pollack said.
CMS increased overall payments for hospital outpatient departments (HOPDs) by an estimated 1.7%. The hospital increase is based on the projected hospital market basket of 2.5%, minus a 0.5% adjustment for economy-wide productivity and a 0.3 percentage point adjustment required by statute.
To read the fact sheet on the CY 2014 final rule with comment period, go to http://go.cms.gov/18iCoM6. The final rule with comment period and final rules appeared in the Dec. 10, 2013, Federal Register and can be downloaded at http://1.usa.gov/18D2a0n. Comments are due by Jan. 27, 2014.