Healthcare News & Insights

CMS releases final rule for OPPS

The Centers for Medicare & Medicaid Services (CMS) has released its final rule for the 2017 Hospital Outpatient Prospective Payment System (OPPS), and there are quite a few changes your facility needs to know about. 

Stethoscope on MoneyOne of the biggest changes concerns site-neutral payments for off-campus provider-based departments, as discussed in a CMS fact sheet about the OPPS. Previously, CMS wanted to implement a new payment system, separate from the OPPS, where all these facilities would be paid at different, lower rates.

Because of outcry over this proposal, CMS came up with a compromise.

According to the fact sheet, instead of applying the changes to all off-campus provider-based departments, certain types are exempt and will be paid at normal OPPS rates, including:

  • off-campus facilities with dedicated emergency departments,
  • off campus facilities that billed for covered services prior to Nov. 2, 2015, and
  • facilities that are located with 250 yards of the main hospital (or a remote location of the hospital).

For facilities that don’t fall into these categories, payment rates will generally be around 50% of the OPPS rate, according to a news brief from the American Hospital Association (AHA).

Hospitals that are exempt from the reduced payment rates will lose their grandfathered status if they move to a new location (except if the move is due to extraordinary circumstances). But they can still keep their status if they offer new services at the same location – which wasn’t a previous stipulation in the original proposed rule.

While many hospitals will breathe a sigh of relief for the flexibility the final rule will bring them with their off-campus provider facilities, it may be tough for facilities that aren’t grandfathered into the OPPS.

The AHA said it’s reviewing the new rule closely to make sure the payment difference isn’t too much of a burden on hospitals, and it will suggest revisions to CMS as it deems them appropriate.

More key changes

Besides site-neutral payments, the final rule addresses several other areas. Overall, payment rates for hospitals are expected to rise. Between adjustments made by CMS and rate updates, hospitals should see a modest increase of 1.7% in 2017.

The rule also includes new details of the outpatient quality reporting program. It’s adding seven measures to the program for 2017 that’ll determine payment rates in 2020. The measures deal with admissions and emergency department visits for patients receiving outpatient chemotherapy, hospital visits after hospital outpatient surgery and patient satisfaction levels as measured from surveys.

In addition, CMS is removing the answers to pain management questions on patient satisfaction surveys from consideration when determining a hospital’s performance through the Hospital Value-Based Purchasing Program. This happened after healthcare professionals expressed concerns that providers would feel pressured to alter their prescribing practices to make patients happy and boost scores.

And CMS has officially changed the reporting period for the Electronic Health Record (EHR) incentive program. Now, reporting can take place within a continuous 90-day period for all eligible hospitals, critical access hospitals and professionals that have previously met meaningful use requirements. The agency first allowed for a 90-day reporting period in 2016 – and the final rule extends that to 2017 as well.

Additional areas addressed in the final rule include organ transplant enforcement, payment rates for partial hospitalization programs and device-intensive procedure policies.

Hospitals may want to review the fact sheet, or the final rule in its entirety, to find all the updates that apply to their specific facilities so they can be fully prepared. CMS is also still reviewing comments about certain changes, which the agency may take into consideration once they’re implemented.

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