Drug Criteria & Outcomes
CMS publishes 2009 payment proposal
The Centers for Medicare & Medicaid Services (CMS) continues its transformation of how it pays ambulatory surgical centers (ASCs) and hospitals for outpatient services, but each iteration of the four-year project nonetheless manages to raise a fresh round of objections.
In this instance, operators of ASCs are feeling the pinch. Whether Congress will intervene is the open question, but the short time remaining in the current legislative cycle suggests the answer is no.
The July 3 announcement says that the proposed rule "includes a 3.0% annual inflation update to Medicare payment rates" for most services offered by the more than 4,000 hospitals and community mental health centers for calendar year (CY) 2009. On the other hand, two thirds of that 3% update may disappear for hospitals "that do not meet quality reporting requirements."
The agency states that it is "proposing to add four imaging efficiency measures that would be calculated" to the existing seven. CMS also seeks input on another 18 measures for hospital outpatient care, including cancer care and community-acquired pneumonia. The agency is also interested in a data validation system that would pluck 50 records from each of 800 hospitals to "validate the accuracy of reported data."
However, the reduced payment for failure to report the quality data would not apply to pass-through payments for some drugs and devices, to services assigned to new technology ambulatory payment classifications (APCs), or to separately payable radiopharmaceuticals. The overall expenditure under the outpatient prospective payment system to hospitals is projected to rise 9.4%, from $26.9 billion in CY 2008 to $28.7 billion.
CMS says that it intends to expand the number of procedures it will pay ASCs to perform and payment for device-related procedures will be the same as hospital outpatient departments when the use of the device is at least 50% of the total cost. New services that are "predominantly performed in physicians' offices" are capped at the amount paid to doctors providing those services under the Part B physician fee schedule.
The agency also proposes to pay for many imaging services under a composite APC in the case of multiple services provided in a single session. The services that would be subject to the composite payment rubric include magnetic resonance imaging and angiography, both with and without contrast agents, as well as computed tomography imaging and angiography, again both with and without contrasts. CMS intends to accept comments on the proposal until Sept. 2 and will ink a final rule by Nov. 1.
The Centers for Medicare & Medicaid Services (CMS) continues its transformation of how it pays ambulatory surgical centers (ASCs) and hospitals for outpatient services, but each iteration of the four-year project nonetheless manages to raise a fresh round of objections.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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