The CMS on Friday proposed a 2.1% payment rate increase (PDF) to hospital outpatient departments and a 1.3% boost to ambulatory surgery centers for 2013.
Based on these rates, the CMS expects total payments for services to Medicare beneficiaries at hospital outpatient departments to total about $48.1 billion next year, while payments to ambulatory surgery centers should amount to about $4.1 billion.
Payments to hospital outpatient departments are based on a formula that is equal to the hospital market basket—which represents an inflation rate of goods and services hospitals use for inpatient services—of 3% minus a 0.9% adjustment for productivity. The agency also indicated that it will continue a 2% reduction in payments for those hospitals that don't meet hospital outpatient quality reporting requirements.
Services in the outpatient prospective payment system are categorized into groups called ambulatory payment classifications. Under the newly proposed rule, the CMS recommends using a so-called geometric means of cost of services within an ambulatory payment classification, as opposed to the median costs that have been used since the outpatient prospective payment system was established. The Medicare Payment Advisory Commission has described “geometric mean” as a measurement that gives less weight to unusually long lengths of stay than an arithmetic mean, which produces a lower estimate of the average length of stay.