Proposed rules would raise rates, cut doc reimbursement

The CMS issued proposed Medicare rules that would increase hospital outpatient rates by 1.5%, increase ambulatory surgical center payments by 0.9%, and decrease physician reimbursement by 29.5%, with the cut coming as a result of previous delays of mandated cuts tied to the sustainable growth-rate formula.

The proposed rule increasing payments for care beginning Jan. 1, 2012, also would amend the Hospital Value-Based Purchasing program to add a clinical process of care measure to guard against infections from urinary catheters. The proposal also would establish performance periods, standards and a “weighting scheme” for the fiscal 2014 hospital program.

The value-based purchasing program, established under a final rule issued in April, will tie a portion of a hospital's payment for inpatient stays to its performance score on a set of quality measures. Another component of the proposed rule would establish a process for certain physician-owned hospitals to apply for an exception to the Patient Protection and Affordable Care Act's ban on capacity expansions at such facilities. The proposed rule also would amend the Medicare Electronic Health Record Incentive Program to allow eligible hospitals and critical-access hospitals to begin reporting clinical quality measures in 2012 through an electronic reporting pilot. The proposed rule also would establish a first-time quality reporting program for ASCs under the Hospital Outpatient Quality Reporting Program.