Last week, the Centers for Medicare and Medicaid Services (CMS) published the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Hospital outpatient departments and ASCs will receive a 2.9% raise next year.
The boost includes a 3.4% market basket boost minus 0.5% for multifactor productivity projected to add $2.2 billion to OPPS payments for hospitals compared to 2024. According to Fierce Healthcare, the policies affect 3.500 hospitals and 6,100 ASCs. Next year is the last year ASCs will receive a productivity adjustment.
Under the OPPS, hospitals are required to meet new quality standards for obstetrical care in order to qualify for Medicare reimbursement. This includes a new staffing requirement that nurses, midwives or other practitioners attending obstetrical patients will have required training and basic obstetric equipment readily available, Modern Healthcare reports.
In a CMS press release, Administrator Chiquita Brooks-LaSure noted that the OPPS includes other hospital incentives:
Additionally, the CY 2025 hospital Outpatient Prospective Payment System final rule expands access to behavioral health services, increases access to certain high-cost drugs for those facing cancer in tribal communities, and addresses barriers to Medicare coverage for those formerly incarcerated.
The OPPS also doubles the Medicare reimbursement that hospitals receive for performing coronary computed tomography angiography (CCTA). According to Cardiovascular Business, the update raised the CCTA payment rate from $175 to $357.13.
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