CMS Finalizes CY2024 Outpatient and ASC Payment System (OPPS)-Small Increase

The Centers for Medicare and Medicaid Services (CMS) released the CY2024 Outpatient and Ambulatory Surgical Center Prospective Payment System (OPPS), which included an increase for outpatient hospitals and ASCs of 3.1%.

The final rule’s raise was larger than the 2.8% initially proposed, which the agency attributed to industry response to the proposed rule. According to Modern Healthcare, the rule will include changes to the hospital price transparency rule based on updated laws, and will require hospitals to confirm the accuracy of their pricing information in writing to CMS.

The rule also establishes the Intensive Outpatient Program, which expands access to immediate health care services for patients with mental health needs who do not require hospitalization. The program will be operated by hospital outpatient departments, community mental health centers and rural clinics.

Hospitals were quick to respond to the final rule with concerns that increases in reimbursement will not be sufficient for hospitals to continue to effectively operate. Stacey Hughes, the American Hospital Association’s (AHA) executive vice president, released a statement criticizing the agency for not responding to hospitals’ needs:

Today’s increase for outpatient hospitals of only 3.1% comes in spite of persistent financial headwinds facing the field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day. Hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be in jeopardy, which is why the AHA is urging Congress for additional support by the end of the year.