Healthcare News & Insights

4 big changes for hospitals in proposed OPPS rule

The Centers for Medicare & Medicaid Services (CMS) recently released its proposed rule for the 2017 Hospital Outpatient Prospective Payment System (OPPS), and there are several changes coming that’ll affect how your facility bills for the services it provides. 

153790263Overall, there’s good news: The proposed rule will actually increase payments under OPPS by 1.6%.

While most other changes are positive, some may not be as beneficial to hospitals.

Here’s a rundown of four of the most significant updates in the proposed rule, as written in a press release from CMS.

1. Surveys for pain

One proposed change may be welcome for hospitals: CMS is removing the questions about pain management from patient satisfaction surveys.

Many facilities expressed concern about these questions in the past. Because the results of these surveys factor into Medicare payments, hospitals felt asking about pain management unfairly penalized hospitals where providers didn’t automatically prescribe patients opioids, while rewarding those that did.

To reduce the chance that patient satisfaction surveys would influence prescribing practices in this way, CMS opted to remove the current questions as written.

However, the agency did state that evaluating how well hospitals treat patients’ pain is still an important part of providing quality care, so it’ll be creating different questions focused on communication between patients and providers about pain. They’ll be included in the survey in future years.

2. Off-campus payments

For hospitals with off-campus outpatient departments, the proposed rule has a payment change that will affect your bottom line. CMS will no longer pay the OPPS rates for certain services that are rendered to patients in off-campus outpatient facilities. Instead, they’ll receive site-neutral payments.

According to CMS, this change came about because the agency was concerned about the trend of hospitals purchasing doctors’ offices so they could earn higher payments for outpatient services.

Patients ended up paying more for services than they would at a stand-alone physician’s office, so the change is designed to keep patients from a larger cost burden due to the settings they chose.

Not surprisingly, many hospitals have already expressed their displeasure at this provision, according to an article in Modern Healthcare. And the American Hospital Association has issued a statement that opposes this portion of the proposed rule, calling it “shortsighted” and detrimental to hospital-based care.

But with the new regulation expected to save close to $500 million in healthcare spending, it may not be easily removed from the rule.

3. EHR updates

Technology also has a prominent role in the proposed rule – particularly electronic health records (EHR) systems. CMS has already started revising the role of EHRs in quality reporting for physicians, and now it’s starting to focus on updating the requirements for hospitals.

In the past, hospitals had to report quality measures via their EHRs over a full calendar year. The proposed rule lowers that significantly – hospitals will be able to use a 90-day reporting period. CMS hopes the change will decrease facilities’ reporting  burdens while making the process more flexible.

Other changes are designed to make EHR technology more useful for monitoring and improving patients’ health.

4. Quality measure updates

In another change related to improving patients’ health, CMS will be adding more quality measures to its reporting programs that are focused on improving patient outcomes and care.

The agency wants to put more emphasis on outcomes that matter to the patient, instead of clinical process measures, and it’s asking for input from hospitals and other healthcare providers about which measures to include.

The proposed rule will be officially published on the Federal Register July 14. Hospitals can submit quality measures or comment on any other portion of the rule until Sept. 6.

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