The CMS on Friday will move forward with site-neutral payments for doctor's visits, even though a federal judge ruled against the policy earlier this year.
The Trump administration will roll out the payments under the Outpatient Prospective Payment System, which will pay doctors the same amount for a basic visit whether it takes place in a hospital outpatient facility or a regular doctors' office. The CMS estimates that the change will cut copays for people on Medicare and slash federal spending by $800 million in 2020. Outpatient clinics are more expensive than physicians' offices, and shifting visits to a lower cost setting could save money.
"The final rule's continued payment cuts for hospital outpatient clinic visits not only threatens access to care, especially in rural and other vulnerable communities, but it goes against clear congressional intent to protect the majority of clinic services," said Tom Nickels, Executive Vice President of the American Hospital Association. "Now that a federal court has sided with the AHA and found that these cuts exceed the Administration's authority, the CMS should abandon further illegal cuts."
Medicare will also pay for more procedures that take place in ambulatory surgical centers, which can often perform surgeries at a much lower cost than hospitals.
The OPPS will update the wage index that is used to pay providers, which should benefit rural providers who have said they need higher reimbursements because it's more expensive for them to provide care.
The rule also slashes drug payments to safety-net hospitals under the 340B program by changing the formula it uses to calculate reimbursements.
The 340B program will be cut by $1.6 billion, according to Richard Sorian of 340B Health. The cuts are budget neutral and Medicare will use the drug savings to pay hospitals for additional services.
"By plowing ahead with damaging cuts to hospitals in the 340B drug pricing program and ignoring clear congressional intent by expanding cuts to grandfathered provider-based outpatient clinics, CMS undermines the foundation of care for the nation's most vulnerable people," said Beth Feldpush, senior vice president of policy and advocacy for America's Essential Hospitals. "The agency also prolongs confusion and uncertainty for hospitals by maintaining unlawful policies it has been told to abandon in clear judicial directives."
Litigation related to the drug cuts is currently making its way through the courts.
The final rule doesn't include the Trump administration's proposal on price transparency, which would have forced hospitals to disclose how much insurance companies actually pay them for medical services. The rule had been met with fierce opposition from hospitals, who said that it would increase the cost of health coverage and reduce access to care. The administration touted the proposal earlier this year, saying that price transparency would increase competition among providers and drive down healthcare costs.
"Hospital pricing has been a mystery, but thanks to the leadership of President Trump, those days are over," said CMS Administrator Seema Verma earlier this year.
The proposal's absence from the final rule suggests that hospital pricing will remain "a mystery" for a while longer.
