The Centers for Medicare & Medicaid Services yesterday announced it will increase payment rates under its Outpatient Prospective Payment System (OPPS) by 1.9 percent and its Ambulatory Surgical Center (ASC) payments by 1.6 percent in 2012.
The final rule also expands the measures to be reported under the Hospital Outpatient Quality Reporting Program, creates a new quality reporting program for ASCs and strengthens the Hospital Value-based Purchasing (Hospital VBP) program that is scheduled to go into effect Oct. 1, 2012.
"The CMS is committed to the goal of improving the quality and safety of care in all settings for all patients," said CMS Administrator Donald M. Berwick, MD, in an announcement detailing the final rule. "Using the tools made available under the Affordable Care Act, CMS is moving aggressively to reform the payment and healthcare delivery systems to provide better care at lower costs through improvement."
[See also: CMS issues proposed rules impacting payment rates; CMS proposes new Medicare hospital inpatient value-based purchasing program]
According to CMS, total projected payments for the 2012 calendar year under the OPPS will be $41.1 billion. The 4,000 hospitals expected to receive payment under the program include general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children's hospitals and cancer hospitals. CMS also projects that payments to approximately 5,000 Medicare-participating ASCs paid under the ASC Payment System will be approximately $3.5 billion.
The final rule also provides a payment adjustment for designated cancer hospitals as required by the Affordable Care Act. This payment adjustment is expected to increase payments to cancer hospitals by 11.3 percent – approximately $71 million – over what they would have otherwise been paid.
In addition to the payment increases, CMS also established an electronic reporting pilot that will allow additional hospitals, including critical access hospitals that serve rural areas, to report clinical quality measures in 2012 for purposes of participating in the Medicare Electronic Health Record Incentive Program.
The final rule also addresses a concern expressed by providers that the requirement of direct physician supervision of outpatient hospital therapeutic services could hinder access to care, especially in rural areas. In response, CMS established an independent advisory review process to consider requests that specific outpatient services be subject to a level of supervision other than direct supervision.
Other provisions of the final rule include:
- Payment for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals, other than new drugs and biologicals that have pass-through status, at the average sales price (ASP) plus 4 percent.
- Payment for partial hospitalization (PHP) services in hospital-based PHPs and community mental health centers based on the unique cost-structures of each type of program. For both types of providers, CMS proposes to update the four PHP per diem payment rates based on the median costs calculated using the most recent claims data for each provider type.