Skip to main content
Sister Publication Links
  • ESG: THE IMPLEMENTATION IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Digital Health
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Unwell in America
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Policy
July 15, 2022 05:34 PM

Hospital outpatient providers could see $6.2B pay bump in 2023

Maya Goldman
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    071822EP--hospital-money_costs_i.jpg

    Hospital outpatient providers could see a $6.2 billion increase in Medicare reimbursements next year under a proposed rule issued Friday.

    In addition, the draft regulation provides more details on the agency's new rural emergency hospital program, which is designed to help facilities in remote areas remain open.

    Medicare would pay 2.7% more for outpatient and ambulatory surgical center services in 2023 under the proposed rule. The agency also would extend reimbursement for behavioral telehealth care beyond the COVID-19 pandemic and would offer higher payments when providers purchase U.S.-made N95 respirators, which typically are costlier than foreign-made products. The rule offers insight into how CMS may respond to a recent Supreme Court decision on 340B payment cuts, as well.

    "We are deeply concerned about CMS's proposed payment update of only 2.7%, given the extraordinary inflationary environment and continued labor and supply cost pressures hospitals and health systems face," American Hospital Association Executive Vice President Stacey Hughes said in a news release. "A much higher update is warranted."

    Rural emergency hospitals

    CMS proposed conditions of participation for the new rural emergency hospital designation last month that include eliminating acute care inpatient services. The draft outpatient payment regulation offers more insight into how the agency wants to run the rural emergency hospital program, which is designed to help facilities in remote areas remain open. Some rural hospital leaders are skeptical the initiative will have much impact.

    Facilities designated as rural emergency hospitals would be eligible for a 5% Medicare reimbursement boost for covered outpatient services. The outpatient payment rule proposes that this not translate into higher coinsurance costs for beneficiaries. The regulation states that all outpatient services these hospitals provide would be deemed rural emergency hospital services. Rural emergency hospitals can provide other services, although they wouldn't receive extra payments for them. Under the proposal, rural emergency hospitals would get monthly facility payments that rise annually based on the hospital market basket.

    CMS proposes extending exceptions under the self-referral law to allow physician ownership or investment interests in rural emergency hospitals. The statute known as the Stark law after late Rep. Pete Stark (D-Calif.) prevents physicians from directing Medicare patients to providers in which they have financial stakes. CMS suggests revising the policy to make existing exemptions applicable to compensation agreements to which rural emergency hospitals are parties, according to the fact sheet.

    CMS also wants to reduce the administrative burden for critical access hospitals seeking rural emergency hospital status, which the agency believes could help ease provider enrollment into the new program.

    CMS asks for feedback on Rural Emergency Hospital Quality Reporting Program measures and on considerations for reporting results stratified by patients' social risk factors and demographics. CMS also wants to know if it should release further information on provider mergers, acquisitions, consolidations and ownership changes. The agency released data on hospital and nursing home ownership this year.

    The agency plans to release the final conditions of participation and payment policies for rural emergency hospitals in a single final rule this fall.

    340B

    Additionally, CMS intends to withdraw payment cuts for drugs acquired through the 340B program in 2023. Last month, the Supreme Court ruled that CMS improperly reduced reimbursements for 340B drugs when it changed payment policy in 2018.

    CMS wasn't able to adjust its proposed continuation of these cuts for next year due to the timing of the court decision, but plans to eliminate them in a final rule. CMS also asks for comments on how to remedy the reductions implemented between 2018 and 2022. The policy was budget-neutral and the agency already redistributed the savings from the 2018 cuts to hospitals.

    Telehealth

    The draft regulation also addresses reimbursements for behavioral telehealth services. CMS proposes paying for remote mental healthcare after the COVID-19 emergency ends. Medicare would pay a hospital outpatient department for telehealth and audio-only care so long as the provider has seen a patient within six months prior to the commencement of remote services and sees them at least once a year afterward. CMS would allow certain exceptions to the in-person visit requirement.

    Personal protective equipment

    The agency also outlines a potential pay increase to compensate hospitals for the extra cost of buying domestically produced N95 respirators. Payments would be made biweekly and reconciled in cost reports.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    hospital mask mandate ending
    Hospitals re-evaluate masking, PPE as state mandates end
    Adderal-overprescribe.png
    DEA's proposed remote prescribing rule draws criticism
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Digital Health
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Unwell in America
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing