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 in announcing the rule prior to the July 4 holiday weekend.
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.
The CMS is seeking public comment on options for modifying payments for treating conditions that are generally preventable if the provider follows established guidelines.
After a quick review of the proposal, American Hospital Association officials said the rule also outlines the process for validating hospitals' quality data; proposes adding four new imaging efficiency quality measures for public reporting to qualify for a full update in 2010; and seeks comments on 18 other quality measures that potentially could be included in future rules.
The rule would alter how CMS pays for imaging services when certain multiple services are provided in one session and changes the way partial hospitalization services are paid, the AHA's analysis indicated.
The rule will appear in the July 18 Federal Register, and CMS will accept comments until September 2.