The CMS last week proposed a number of Medicare payment changes for physicians and hospital outpatient services that it said would reduce unnecessary spending and improve patient care.
It proposed moving ahead with a two-year phase-in of reductions in payments for visits furnished in hospital-owned, off-campus clinics. The agency said this would save Medicare $810 million in 2020, while saving beneficiaries an average of $14 in cost-sharing per visit.
The American Hospital Association said the so-called site-neutral policy would hurt access to care and exceed the CMS’ legal authority.
In another move that could ding hospitals financially, the CMS proposed allowing Medicare to pay for total knee replacements and three coronary procedures in ambulatory surgery centers starting next year. The agency allowed them to be reimbursed in hospital outpatient surgery centers starting this year.
In addition, the CMS proposed that Medicare be able to pay for total hip replacements in hospital outpatient departments, marking the first step on the road to allowing payment in ambulatory surgery centers.
These moves would force hospitals to scramble to compete with ambulatory centers in order to retain their lucrative joint replacement business. The Ambulatory Surgery Center Association called the CMS proposals a “win-win” for patients and the Medicare program because it said outpatient joint replacement has shown good outcomes, lower costs and quicker recovery times.
In a move to help struggling rural hospitals, the CMS proposed increasing the wage index on which Medicare outpatient payments are based for certain low-wage index hospitals in 2020, while decreasing the index for high-wage index facilities.
This mirrors what the agency proposed earlier this year in the inpatient prospective payment system rule.
The goal is to help narrow payment disparities that some say is driving rural hospital closures.
“You’d think this generally would be helpful to rural hospitals, but there could always be surprises as to who’s high wage and who’s low wage,” said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy.
On physician payment, the American Medical Association and the American Osteopathic Association were pleased that the CMS proposed to revise documentation and coding for evaluation and office visits in 2020.
The agency also proposed adopting AMA-recommended values for evaluation-and-management visit codes for 2021, which would boost pay for these visits. Ginsburg and other experts say evaluation-and-management visits long have been undervalued and underpaid relative to procedural services.
On the other hand, the CMS signaled it is considering cutting Medicare payments to surgeons as part of revising global payment codes for 10- and 90-day surgery bundles including postoperative visits. The agency said it was holding off on making AMA-recommended code changes.
Citing three new RAND Corp. reports it commissioned, the agency noted that there are far fewer postoperative visits than expected, suggesting the need to revalue global surgery payments downward.
The American College of Surgeons said it’s “extremely disappointed” the CMS isn’t increasing pay per relative value unit for surgeons and that it’s “highly inappropriate” to rely on the RAND reports.
“This could be a very big change, with a significant cut in surgeons’ payments,” Ginsburg said.
To encourage more physicians to treat opioid abuse patients, the CMS wants to create a new Medicare coding and payment for bundled episodes of care for management and counseling of opioid use disorders.
The codes would cover a monthly bundle of services including care coordination, individual and group psychotherapy, and substance use counseling.
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