The CMS wants to cut reimbursement rates for outpatient services. Provider groups immediately slammed the proposals, saying they undervalue outpatient care.
For 2016, the agency proposes a 0.2% cut to outpatient prospective payment system (OPPS) rates.
While those changes might seem small, approximately 3,800 hospitals and 60 community mental health centers are paid under the OPPS and the decrease means they'll collectively receive an estimated $43 million less than they got in 2015.
On the flip side, ambulatory surgical centers will get a modest 1.1% bump.
That will result in the 5,300 ASCs currently being reimbursed by Medicare getting an estimated $186 million more than what they got this year.
Both proposals were immediately criticized by provider trade groups.
“We are deeply disappointed (that the) CMS has proposed a negative update for hospital outpatient services,” Rick Pollack, executive vice president at the American Hospital Association, said in a statement.
Some take issue with the way the CMS calculates ASC rates, which are annually updated for inflation by the percentage increase in the Consumer Price Index. Hospitals rates, on the other hand, are based on a measure known as hospital marketbasket. One advocacy group says not getting a larger bump for ASCs is especially hurtful to the elderly.
The rate “offers more evidence of the CMS' unwillingness to recognize that the agency must do more to actively promote ASCs as a high quality, efficient provider of outpatient care for America's seniors if we are to survive and thrive in the future,” Bill Prentice, CEO of the Ambulatory Surgery Center Association, said in a statement.
The CMS also revealed new quality measures that both providers proving outpatient services must track and report. Failure to do so will result in a 2% reduction in Medicare reimbursement.
Starting in 2019, those under OPPS will be held accountable for two measures related to bone metastases and patient transfers to other healthcare facilities.
The agency will accept comments on the proposed rule until August 31. A final rule is expected Nov. 1.