Medicare is proposing to increase payment rates for outpatient services by 3% to more than 4,000 hospitals and other facilities next year in an inflation rate update under the Outpatient Prospective Payment System.
The CMS projects it will pay these providers $28.7 billion in calendar year 2009, compared with projected payments of $26.9 billion this year.
In addition, the CMS projects it will pay $3.9 billion to ambulatory surgery centers, an increase from the $3.5 billion these facilities were projected to receive in 2008.
Congress froze ASC payments for six years with 2009 as the last year of the freeze, according to Kathy Bryant, president of the ASC Association, so ASCs are not getting a payment update. Increases in volume, changes in case mix and payment for procedures not previously covered, however, could account for the rise in payments from $3.5 billion to $3.9 billion.
The agency has recently begun tying outpatient payments to quality of care. For next year, the CMS is proposing to add four new measures on imaging efficiency to seven existing measures hospital outpatient departments must report data on in 2008, to get full payment for these services next year. Hospitals that dont meet these quality reporting requirements are penalized with a 2% payment reduction.
The agency is seeking comment on 18 additional quality measures that could be added to this list in the future, ranging from screening for fall risk, to cancer care.
Beth Feldpush, senior associate director for policy with the American Hospital Association, said the AHA had concerns that none of the newly proposed measures have been endorsed by stakeholder quality organizations such as the National Quality Forum or Hospital Quality Alliance.
To promote efficiency in paying for imaging services, the CMS is proposing to make just one payment for multiple services of a particular type (such as multiple ultrasound procedures) conducted during a single hospital session. It is also seeking comment on options to modify outpatient payments for preventable or never events. The agency has already implemented a similar policy for preventable conditions acquired during an inpatient stay. -- by Jennifer Lubell