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October 26, 2018 (Cleveland)

The Center Submits Comments on Proposed Outpatient Prospective Payment System Rule

Outpatient Prospective Payment SystemWith hospitals in Northeast Ohio predicted to lose in excess of $37 million, The Center for Health Affairs in late September submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the calendar year 2019 Medicare outpatient prospective payment system (OPPS) proposed rule. In particular, The Center asked CMS to reconsider a provision of the rule that would result in these significant reimbursement losses for services provided through hospital outpatient departments.

Under the proposed rule, hospitals will be paid the physician fee schedule rate for evaluation and management services provided through their outpatient departments, resulting in reimbursement at just 40 percent of the OPPS rate. However, on two separate occasions, once in the Bipartisan Budget Act of 2015 and the second in the 21st Century Cures Act in 2016, Congress established and reaffirmed its intent that hospital outpatient departments existing or under construction when the Bipartisan Budget Act was passed should be granted grandfather status, exempting them from this new lower reimbursement rate.

In comments, The Center urged CMS to consider the negative impact on providers and, ultimately, their ability to deliver healthcare to seniors. The Center emphasized that these hospital outpatient departments in Northeast Ohio are caring for the most vulnerable patient populations, often in very difficult areas to serve. The proposed cuts will have an immediate impact on how health systems treat medically complex patients and coordinate specialty and primary care services.

The Center is joined by 48 Senators and 138 members of the House of Representatives who have also signed letters to CMS expressing concerns and urging reconsideration of this proposal. The outpatient prospective payment system final rule is expected to be issued on or around Nov. 1.

For more on this and other reimbursement issues, contact us.