THE CENTERS for Medicare & Medicaid Services has released a massive proposed rule to update its approach for paying for hospital outpatient and ambulatory surgery center services.
Under the rule, CMS proposes a continued transition to new ambulatory surgery center rates for 2009.
The new rates are based on a 50-50 blend of the 2007 payment rate and the 2009 payment, which represents 65 percent of the hospital outpatient rate.
The new rule, which encompasses more than 1,250 pages, also takes steps to improve the quality of services in hospital outpatient departments and surgery centers.
"The proposed rule builds on efforts across Medicare to transform the program into a prudent purchaser of healthcare services, paying based on quality of care, not just quanitity of services," CMS officials said.
The rule updates rates paid under the outpatient prospective payment system and the ambulatory prospective payment system, in the second of four years of a transition that aims to align rates with the ambulatory payment classification groups that are used to pay for services in hospitals' outpatient departments.
The proposed rule includes a 3 percent annual inflation update to Medicare payment rates for most services that would be paid under the outpatient PPS. That increase would apply to hospitals that report data on seven outpatient quality measures. Facilities not submitting the data would receive only a 1 percent update.
More than 4,000 hospitals and community mental health centers are expected to participate in the program in 2009, CMS officials estimate. The agency projects that hospitals would get $28.7 billion for outpatient services furnished to Medicare beneficiaries. In addition, the CMS expects to make payments of almost $3.9 billion to 5,300 ambulatory surgery centers that participate in Medicare.
According to an analysis by the Ambulatory Surgery Center Association, the proposed 2009 rates differ from the 2008 rates. Under the proposed changes, reimbursement for 92 procedures would decrease, while reimbursement for 2,475 procedures would increase. The proposal adds six procedures to the ASC list of procedures and does not delete any procedures.
The CMS is seeking public comment on options for modifying payments for treating conditions that are generally preventable if the provider follows established guidelines.