The CMS will raise Medicare payment rates next year to hospital outpatient departments and ambulatory surgery centers by 2.2% and 1.4%, respectively. Both rates are marginally higher than what the agency originally proposed this past summer.
The 1,052-page final rule (PDF), which the CMS released in a Friday evening regulation dump, will affect more than 4,000 hospitals and 5,300 ambulatory surgery centers, effective Jan. 1.
In July, the CMS originally pitched payment increases of 2.1% and 1.2% to hospitals and surgery centers. The government usually institutes higher rates in the final rule, but the 2015 rates are only slightly larger than what the CMS originally wanted to pay.
Overall, Medicare outpatient payments to hospitals in 2015 are expected to total $56.1 billion, up $5.1 billion from this year's expected total. Surgery centers are projected to receive more than $4.1 billion in Medicare payments, up about $236 million from 2014.
The CMS is also moving forward next year with comprehensive ambulatory payment classifications, or APCs. Comprehensive APCs are like mini-DRGs, in which providers are paid a lump sum for certain outpatient services that are heavily dependent on devices, such as a hip replacement or pacemaker procedure. The CMS wants to begin more aggressive payment pilots, such as bundled payments, that cap costs and force providers to work more closely across the continuum of care.
However, the CMS finalized only 25 comprehensive APCs instead of the 28 it proposed in July. The government decided to not implement the bundled payments for two catheter procedures and a type of vascular-access surgery. The CMS would have paid $2,700 and $1,500 for the two catheter procedures and $2,600 for the heart treatment.
“Three of the proposed APCs will not be converted into C-APCs because a significant number of higher-cost non-comprehensive services are often performed with the services assigned to these APCs, and a single payment for the comprehensive service would result in significant underpayment for these select procedure combinations,” the CMS said.
Other changes of note: The CMS said it will continue to provide a supplemental payment to certain rural hospitals and cancer hospitals. The agency also said it will add an outpatient colonoscopy quality measure for the 2018 Hospital Outpatient and ASC Quality Reporting Programs.
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