CMS cracks down on outpatient payments to hospital-run centers, removes pain management from value-based purchasing
Proposal would eliminate any potential financial pressure clinicians may feel to over-prescribe pain medications, especially opioids.
In a move that the Centers for Medicare and Medicaid Services estimates will reduce outpatient prospective payment system spending by approximately $500 million in 2017, the agency has proposed no longer paying for outpatient services at a higher rate.
CMS said Wednesday it would implement a section of the Bipartisan Budget Act of 2015, which provides that certain items and services provided by certain hospital off-campus outpatient departments no longer be paid under the outpatient prospective payment system.
Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department, rather than a physician's office.
This payment differential has encouraged hospitals to acquire physician offices to receive the higher rates, CMS said.
[Also: CMS sets guidelines for access to claims data under MACRA]
This acquisition trend and difference in payment has been highlighted as a long-standing issue of concern by Congress, MedPAC, and the Department of Health and Human Services Office of Inspector General, CMS said.
Congress addressed this issue through the Bipartisan Budget Act of 2015 and CMS is implementing it in the new proposed rule, the agency said.
However, at least one hospital organization decried it as being too narrow an intreptation of the law.
The CMS rule also threatens to reduce access to needed healthcare services in the nation's most underserved communities, according to Bruce Siegel, MD, president and CEO of America's Essential Hospitals.
"The regulatory provisions CMS proposes for new off-campus hospital outpatient departments (HOPDs) fail to recognize the practical challenges of establishing and sustaining health care facilities for vulnerable populations," Siegel said. "The agency's decision to not only limit flexibility, but to withhold hospital payments altogether, will perpetuate health care deserts--urban and rural pockets of poor access to care that persist in all 50 states and the District of Columbia."
CMS's proposed provisions also appear to ignore Congress' intent to apply an alternative payment system for services delivered in new facilities, he said.
"Hospital systems that otherwise would seek to enhance access by establishing new clinics in underserved areas will not do so, as this damaging payment policy makes new outpatient centers economically unsustainable," said Siegel, who urged CMS to work with providers on the issue.
Another CMS rule would address physicians' and other healthcare providers' concerns that patient survey questions about pain management in the hospital value-based purchasing program unduly influences prescribing practices.
CMS has proposed removing the pain management dimension from the hospital value-based purchasing program to eliminate any potential financial pressure clinicians may feel to over-prescribe pain medications.
CMS is also currently developing and field testing alternative questions related to provider communications and pain to include in the program in future years.
CMS said it is also supporting physicians and other providers by increasing flexibility for hospitals and critical access hospitals that participate in the Medicare electronic health records incentive program.
[Also: 231 hospitals with lower quality get value-based purchasing bonuses because of cheaper costs]
The new rule includes a proposal for clinicians, hospitals, and critical access hospitals to use a 90-day EHR reporting period in 2016 – down from a full calendar year for returning participants. This increases flexibility and lowers the reporting burden for hospital providers, CMS said.
Earlier this year, CMS conducted a review of the Medicare EHR Incentive Program for clinicians as part of the implementation of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.
Based on that review, CMS streamlined EHR reporting requirements under the proposed rule to implement certain provisions of MACRA.
Finally, CMS will add new quality measures to the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program that are focused on improving patient outcomes and experience of care.
Other changes in the proposed rule would enhance the outcome requirements for organ transplant programs, so that the programs may help more beneficiaries accept more grafts, while maintaining compliance with Medicare standards for patient and graft survival.
CMS estimates that the updates in the proposed rule would increase outpatient prospective payment system payments by 1.6 percent and ambulatory surgical center payments by 1.2 percent in 2017.
The proposals are based on feedback from stakeholders, including beneficiary and patient advocates, as well as health care providers, including hospitals, ambulatory surgical centers and the physician community.
"The items in this proposal are designed to improve care and value when Medicare beneficiaries receive care in an outpatient setting," said Acting CMS Administrator Andy Slavitt. "Today's proposed updates better support physicians in providing beneficiaries with the right care at the right time."
Twitter: @SusanJMorse
