OPPS rule impacts obs, adds quality measures
Hospitals to get 2.35% pay rate increase
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule for hospital outpatient departments (HOPDs) for calendar year (CY) 2011 with a payment rate increase of 2.35%.
The Affordable Care Act requires CMS to reduce the HOPD fee schedule increase factor (often referred to as the hospital operating market basket increase factor) for the CY 2011 Outpatient Prospective Payment System (OPPS) payment by 0.25%. Accordingly, CMS has calculated the CY 2011 OPPS payment rates to reflect a hospital operating market basket increase factor of 2.35%, which is the market basket of 2.6% minus the 0.25% reduction.
Among the changes that could impact EDs in the next fiscal year include modification of several supervision requirements for outpatient therapeutic services, including:
- Requiring direct physician supervision for only the initiation of certain services and allowing general supervision once the treating practitioner deems the patient medically stable. This two-tiered approach to supervision applies to a limited set of non-surgical extended duration services, including observation services.
- Redefining direct supervision for all hospital outpatient services to require "immediate availability" without reference to the boundaries of a physical location.
A more direct impact will be felt in the fiscal years of 2012 and 2013, with the addition of eight quality measures for payment determination. Six of these are chart-abstracted measures of timeliness and appropriate care in the ED, including time to pain management for long bone fracture; door to diagnostic evaluation by a qualified medical professional; head CT scan results for acute ischemic stroke or hemorrhagic stroke who received head CT scan interpretation within 45 minutes of arrival; patient left without being seen; median time from ED arrival to ED departure for discharged ED patients; and transition record with specified elements received by discharged patients.
The complete OPPS rule can be found at www.cms.gov/HospitalOutpatientPPS.
The Centers for Medicare & Medicaid Services (CMS) has issued a final rule for hospital outpatient departments (HOPDs) for calendar year (CY) 2011 with a payment rate increase of 2.35%.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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