The final 2019 Hospital Outpatient Prospective Payment System (OPPS) rule with comment period phases in cuts to hospital outpatient clinic visits and bumps ambulatory surgical centers (ASCs) average reimbursement rate per procedure by 2.1 percent while hospital outpatient surgery departments get 1.35 percent more next year.
The new rule also updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.
The agency’s drive to make payments for clinic visits site neutral materialized with the rule’s 60 percent reduction in payment rates for hospital outpatient clinic visits from off-campus departments. The new policy will be phased in over two years, with half of the reduction applying in 2019.
Executive VP of The American Hospital Association, Tom Nickels, responded to the rule – the association is threatening legal action against the feds for the new provisions,
This rule, which phases in over two years payment cuts to hospital outpatient clinic visits, is based on unsupportable analyses and erroneous policy rationales. These ill-advised cuts will hit patients in rural and vulnerable communities especially hard.
Based on this update, CMS estimates that total payments to OPPS providers for CY 2019 will be approximately $74.1 billion, an increase of approximately $5.8 billion, year-over-year (YOY). The agency estimates total payments to ASCs for CY 2019 will be approximately $4.85 billion, an increase of approximately $200 million YOY.
The new rule also provides that in 2019 the definition of surgery in the ASC payment system will account for certain surgery-like procedures that are assigned codes outside the current surgical range. The agency added 12 cardiac catheterization procedures and five related procedures to the ASC covered services list.
Read the rule: Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs.
Read the 6 things you should know about the rule from Becker’s ASC Review
Check out the press release from The American Hospital Association
Read more about the opposition to site-neutral payments from Patient Engagement HIT
Site neutral payments
Link to rule:
Medicare Program: Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs