CMS rules on site neutral payments, pain meds

The Centers for Medicare and Medicaid Services addressed site neutral payments, pain management amid the opioid crisis, and changes to lower the reporting burden of electronic health records, in a proposed final rule released Tuesday.

Currently, Medicare pays for the same services at a higher rate if these services are provided in a hospital outpatient department rather than a physician's office.

[Also: CMS proposes payment rate changes for hospital outpatient departments and ASCs]

This payment difference has provided an incentive for hospitals to acquire physician offices to receive the higher rates, has increased costs for Medicare and raised the cost-sharing liability for beneficiaries, CMS said.

Congress, the Medicare Payment Advisory Commission, and the Department of Health and Human Services Office of Inspector General have all voiced concern for the trend.

Starting Jan. 1, 2017, CMS is implementing the Bipartisan Budget Act of 2015 requiring that items and services furnished by off-campus hospital outpatient departments be site neutral, and no longer paid under the outpatient prospective payment system.

The final rule describes which off-campus hospital outpatient departments are subject to this requirement and which items and services are exempted and will continue to be paid the higher rate.

Additionally, CMS is issuing an interim final rule to establish new payment rates under the Medicare physician fee schedule for the items and services provided by certain off-campus provider-based departments. 

These payment rates are in lieu of finalizing a proposal as numerous commenters raised concerns, CMS said.

The new interim final rates being adopted will permit hospitals to be paid for furnishing items and services that may no longer be paid under the outpatient prospective payment system.

"We believe (this) will reduce incentives for hospitals to acquire independent physician practices and convert the same service into more highly paid OPPS services," CMS said. 

CMS is also addressing physicians' and providers' concerns that patient survey questions about pain management unduly influences prescribing practices.

[Also: Children, toddlers flood hospital emergency rooms due to opioid poisoning, study finds]

While there is no evidence of such an effect, CMS said, the agency is finalizing the removal of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey for purposes of the hospital value-based purchasing program, to eliminate any financial pressure clinicians may feel to overprescribe medications.

CMS said it continues to believe that pain control is an appropriate part of routine patient care that hospitals should manage, and is an important concern for patients, their families, and their caregivers. 

CMS will be seeking comment on alternative questions related to  pain for future rulemaking.

Outpatient final rule updates for 2017 would increase payments by 1.7 percent and ambulatory surgical center rates by 1.9 percent, according to CMS.

CMS is supporting physicians and other providers through the rule by increasing flexibility for eligible professionals, hospitals and critical access hospitals that participate in the Medicare and Medicaid electronic health record incentive programs.

On October 14, CMS released the final rule on the new quality payment program for clinicians, which includes provisions establishing the Merit-Based Incentive Payment System.

CMS is eliminating the clinical decision support and computerized order entry objectives under the Medicare EHR incentive program for providers, including dual-eligible hospitals. The new measure begins in 2017.

[Also: Medical groups ask CMS chief Andy Slavitt to finalize 90-day EHR reporting]

CMS is reducing a subset of thresholds for the remaining objectives and measures for Modified Stage 2 and Stage 3, it said.

Additional changes include allowing all returning participants in the EHR incentive programs to report on a 90-day EHR reporting period in 2016 and 2017.

CMS is also finalizing an application process for a one-time significant hardship exception to the Medicare EHR incentive program for certain professionals in 2017 who are transitioning to MIPS.

These additions are aimed at lowering the reporting burden and focusing on the exchange of health information and technology.

"We spoke to stakeholders across the outpatient community who care about the quality and value of care that Medicare patients receive," said Sean Cavanaugh, deputy administrator and director of the Center for Medicare at CMS. "The policies finalized in today's rule will not only improve the value of care provided to Medicare beneficiaries, but are also responsive to health care providers who are crucial to outpatient care."

Twitter: @SusanJMorse