Payment changes proposed for hospitals, surgery centers
The Centers for Medicare & Medicaid Services (CMS) has proposed a 3% payment increase for hospital-based outpatient programs for calendar year (CY) 2009, while ambulatory surgery specialties will see payment changes ranging from -6% for procedures on the digestive system to 19% for procedures of the musculoskeletal system. (See impact by surgical specialty below.)
Impact on Ambulatory Surgery Specialties For 2009, the Centers for Medicare & Medicaid Services (CMS) estimates the following impact under the blended rate for ambulatory surgery specialties:
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The proposed rule will update rates paid under the ambulatory surgery center prospective payment system, which will be in the second year of a four-year transition to ambulatory payment classification (APC) groups that are used for hospital outpatient payments. ASC services will be paid at a 50/50 blend of the 2007 ASC payment and the 2009 ASC payment, which equals 65% of the hospital outpatient rate, according to the American Hospital Association.
CMS also proposes updating the list of device-intensive procedures and covered ancillary services and their rates, consistent with proposals in the outpatient prospective payment system (OPPS) update.
Beginning in 2009, the annual OPPS payment inflation update is be reduced by 2.0 percentage points for hospitals that don't meet quality reporting requirements. To receive the full OPPS payment update for services furnished in CY 2009, hospitals must report data in CY 2008 on seven quality measures of perioperative surgical care, as well as ED care. CMS is proposing to add four new measures of imaging efficiency to the CY 2010 update. CMS also is seeking comment on 18 more potential quality measures in areas including screening for fall risk. Those are under consideration for future years.
CMS is seeking public comment on options and considerations for modifying payments for treating conditions that generally are preventable if the provider follows established guidelines. CMS already is implementing a similar policy for inpatient stays beginning Oct. 1, 2008. CMS no longer will pay hospitals at a higher rate for treating certain conditions that have been determined to be reasonably preventable by following evidence-based guidelines, if they are acquired during an inpatient stay.
Under the proposed rule, the amount beneficiaries will pay for outpatient services would continue to decline based on a formula in the Medicare law that is designed to provide a gradual transition to 20% coinsurance. CMS estimates that nearly 25% of all types of services furnished in hospital outpatient departments will be subject to the 20% coinsurance rate in CY 2009, up from 23% in CY 2008. However, the services that will be subject to the 20% coinsurance rate in CY 2009 represent a larger proportion of the total number of claims for services paid under the OPPS. As a result, CMS estimates that Medicare beneficiaries overall will be responsible for about 23% of total payments for Medicare covered outpatient services in CY 2009.
The proposed rule can be viewed by going to www.cms.hhs.gov. Comments on the proposed rule will be accepted until Sept. 2, 2008, and a final CY 2009 OPPS/ASC payment rule will be issued by Nov. 1, 2008. At press time, the proposed rule was scheduled to appear in the July 18, 2008, Federal Register.
The Centers for Medicare & Medicaid Services (CMS) has proposed a 3% payment increase for hospital-based outpatient programs for calendar year (CY) 2009, while ambulatory surgery specialties will see payment changes ranging from -6% for procedures on the digestive system to 19% for procedures of the musculoskeletal system.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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