The CMS is moving forward with its plans to expand its site-neutral payment policy to clinic visits, a move that could save the agency hundreds of millions of dollars.
Clinic visits, or checkups, are the most common service billed under the outpatient pay rule. The CMS is instituting a 60% cut for these visits in outpatient departments over a two-year period. This will equate to the CMS paying these departments 70% of the outpatient rate for these visits.
The American Hospital Association plans to team up with Association of American Medical Colleges to sue over the 60% cut as they feel it exceeds the administration's legal authority.
Once fully implemented, the payment change is projected to save Medicare $610 million and patients about $150 million through lower co-payments for doctor visits provided at an off-campus hospital outpatient department.
The hospital lobby opposes the change. The cut ignores the differences between the patients that come to hospital outpatient departments versus other sites of care for treatment, according to Tom Nickels, executive vice president at the American Hospital Association."They are more likely to be poorer and have more severe chronic conditions than patients treated in an independent physician office," Nickels said. "In addition, hospitals are held to far higher regulatory standards because of the complexity of caring for sicker patients."
Overall, outpatient departments will get an increase of $440 million, or 1.35% more than they got in 2018. The pay boost in 2017 was $690 million, which included some redistribution of 340B funds.
The CMS estimates that it was paying approximately $75 to $85 more on average for the same service in hospital outpatient settings compared to physician offices. Beneficiaries were responsible for 20% of that increased cost.
However, the agency held off on its plans to add additional facilities to a site-neutral rule it finalized in 2016. That regulation pays hospital off-campus facilities less than hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015.
The CMS wanted to limit the circumstances under which off-campus facilities that were billing Medicare before November 2015 can expand their clinical services. Without these restrictions, hospitals may purchase more practices and add those physicians to the grandfathered off-campus sites to draw down enhanced outpatient rates, the CMS said.
Following pushback from the American Hospital Association and others, the agency said it decided to not finalize that provision.
But the CMS will expand last year's cuts to 340B discounts given to outpatient facilities. Last year, the agency cut 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.
The CMS is expanding the 340B cut to off-campus provider-based departments to prevent hospitals from moving their drug administration services for 340B-acquired drugs to an off-campus facility to receive a higher payment amount for these drugs.
Hospitals were dismayed by the change as the cut from last year has already started to harm access to care, according to Maureen Testoni, interim president of 340B Health."Our member hospitals report that they have had to cut back on services and have had to forgo hiring or lay off doctors, nurses, pharmacists, and other healthcare professionals," Testoni said in a statement.
The CMS is also looking to reduce regulatory burden on hospitals in the rule. It removed various measures from the Hospital Outpatient Quality Reporting Program and from the Ambulatory Surgery Center Quality Reporting Program. The action will decrease burden for providers by approximately $27 million over the next two years, according to the CMS.The CMS is moving forward with its plans to expand its site-neutral payment policy to clinic visits, a move that could save the agency hundreds of millions of dollars.