Hospital outpatient services get 6.6% increase

Hospitals would receive a 6.6% total increase in payments for outpatient services under a proposed outpatient prospective payment system (OPPS) rule issued for calendar year 2005. The Center for Medicare & Medicaid Services (CMS) includes a 3.3% payment rate increase for OPPS services. This rate increase, along with other policy changes, will increase Medicare OPPS payments from $22.7 billion in 2004 to $24.2 billion, a 6.6% increase in total payments. CMS has suggested these changes:

  • The proposed rule increases payment rates to hospitals for some screening examinations. Flexible sigmoidoscopy increases 7.42%, and screening colonoscopy 9.9%.
  • The rule continues the provision that sets rates for brachytherapy sources on charges adjusted to cost and creates new definitions for new codes for high activity brachytherapy sources.
  • The rule continues the two-year extension of hold harmless payments for small rural hospitals having fewer than 100 beds and for sole community hospitals in rural areas.
  • The rule includes a way for hospitals to receive payment for new drugs and biologicals as soon as they are approved by the Food and Drug Administration.
  • CMS proposes a new fixed dollar threshold, in addition to the current outlier threshold, for outlier payments.

At press time, the proposed rule was scheduled to be published in the Aug. 16 Federal Register. Go to: www.cms.hhs.gov/providers/hopps/. Under "highlights," click on "CMS-1427-P." Comments will be accepted until Oct. 8, and the final rule is scheduled to be published by Nov. 1.