Healthcare Business News

CMS plans to raise outpatient rates, bundle payments for ancillary services

By Bob Herman
Posted: July 3, 2014 - 5:45 pm ET

The CMS has proposed raising Medicare outpatient payments to hospitals by 2.1% in 2015, while ambulatory surgery centers would receive a 1.2% boost, according to a 687-page proposed rule released Thursday (PDF).

Both of those increases are higher than what the CMS proposed and ultimately finalized for 2014.

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The 2.1% update for hospitals was calculated from a 2.7% market-basket increase, minus a 0.4% productivity adjustment and a 0.2% cut required by the Patient Protection and Affordable Care Act. The rate increase for surgery centers reflected a 1.7% update to the consumer price index, offset by a 0.5% productivity adjustment. Certain sole community hospitals in rural areas would still receive enhanced payments.

Hospitals that fail to meet outpatient quality reporting requirements would continue to have their Medicare reimbursements reduced by 2%, according to the rule. But the CMS has also proposed removing three quality measures from the reporting program: emergency department heart attack patients who received aspirin within 24 hours and two metrics involving the administering of antibiotic prophylaxis to surgery patients. The government said hospitals generally performed very well on those measures with little variation.

For 2015, the agency also proposed paying a bundled rate for ancillary services that have an average cost of $100 or less. Exceptions to this packaging payment would include preventive services, psychiatric-related services and drug administration-related services. Since the 2014 proposed rule, the CMS has been pushing for “comprehensive ambulatory payment classifications,” which would result in a single Medicare payment to providers instead of several separate charges. For 2015, the CMS proposed 28 comprehensive APCs.

The rule would affect more than 4,000 hospitals and 5,300 ambulatory surgery centers.

The CMS estimates Medicare would pay hospitals $56.5 billion under the policy in 2015, an increase of $5.2 billion over 2014—most of which reflects adjustments for enrollment, utilization and case mix. ASCs would receive $4.1 billion, an increase of $243 million compared to 2014, according to the proposed rule.

Comments on the draft regulations will be accepted through Sept. 2 and a final rule is expected around Nov. 1.

Follow Bob Herman on Twitter: @MHbherman

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