CMS Proposes Major Cuts to 2018 Medicare Outpatient Payments

Posted on July 14, 2017

On July 13, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to update the Medicare fee-for-service outpatient prospective payment system (OPPS) for 2018. Highlights of the proposed rule include:

  • Significant payment reductions for drugs acquired under the 340B drug discount program. Specifically, the CMS proposes to pay separately payable, nonpass-through drugs, excluding vaccines, purchased through the 340B program at the average sales price (ASP) minus 22.5 percent, rather than at the ASP plus 6 percent.
  • Paying off-campus hospital outpatient departments (HOPDs) at 25 percent rather than 50 percent of the Medicare OPPS rate for nongrandfathered services provided at off-campus HOPDs.
  • A net 1.75 percent payment increase after the 2.9 percent marketbasket increase is adjusted for a 0.4 percentage point adjustment for multifactor productivity and a 0.75 percentage point adjustment mandated by the Affordable Care Act, excluding budget-neutrality adjustment.
  • Reinstatement of the moratorium on the direct supervision requirement for outpatient therapeutic services at critical access hospitals and rural hospitals with 100 or fewer beds.
  • A delay in implementing the measures based on the outpatient and ambulatory surgical center Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey in the outpatient quality reporting program until further notice.
  • Removal of six quality measures from the outpatient quality reporting program.

The MHA, along with the American Hospital Association and others, urge the CMS to withdraw this proposal, which will threaten access to care for vulnerable patients, including those in rural areas, rather than addressing the rising cost of pharmaceuticals.

Click here to view the full edition of Monday Report.In the next few weeks, the MHA will provide additional detail on the proposed rule, including a hospital-specific impact analysis. The MHA will also make its draft comment letter available to members prior to the due date and encourages members to submit their comments to the CMS by Sept. 11. The CMS is expected to release a final rule by Nov. 1 for the Jan. 1, 2018, effective date.

Members with questions should contact Vickie Kunz at the MHA.



Tags: OPPS, proposed rule, CMS, FFS

Posted in: Member News

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