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AMA Votes to Stop ICD-10 Implementation
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CMS Adopts
Policy and Payment Changes for Outpatient Care in Hospitals and
Ambulatory Surgical Centers
The Centers for Medicare & Medicaid Services (CMS) today issued
a final rule with comment period (final rule) that will update
payment policies and payment rates for services furnished to
Medicare beneficiaries in hospital outpatient departments (HOPDs)
and ambulatory surgical centers (ASCs) beginning Jan. 1, 2012.
In addition to establishing payment rates for calendar year (CY)
2012, the final rule expands the measures to be reported under
the Hospital Outpatient Quality Reporting Program, creates a new
quality reporting program for ASCs, and strengthens the Hospital
Value-based Purchasing (Hospital VBP) program that will affect
payments to hospitals for inpatient stays beginning Oct. 1 2012.
CMS projects that total payments to more than 4,000 hospitals –
which includes general acute care hospitals, inpatient
rehabilitation facilities, inpatient psychiatric facilities,
long-term acute care hospitals, children’s hospitals, and cancer
hospitals – paid under the Outpatient Prospective Payment System
(OPPS) in CY 2012 will be approximately $41.1 billion. CMS also
projects that payments to approximately 5,000
Medicare-participating ASCs paid under the ASC Payment System
will be approximately $3.5 billion for CY 2012.
“The CMS is committed to the goal of improving the quality and
safety of care in all settings for all patients,” said CMS
Administrator Donald M. Berwick, M.D. “Using the tools made
available under the Affordable Care Act, CMS is moving
aggressively to reform the payment and health care delivery
systems to provide better care at lower costs through
improvement.”
The final rule also establishes an electronic reporting pilot
that will allow additional hospitals, including critical access
hospitals (CAHs), to report clinical quality measures in CY 2012
for purposes of participating in the Medicare Electronic Health
Record Incentive Program.
Provisions affecting payments to Hospital
Outpatient Departments
The final rule will increase payment rates under the OPPS by 1.9
percent in CY 2012. This increase is based on the projected
hospital inpatient market basket percentage increase of 3.0
percent for inpatient services paid under the Hospital Inpatient
Prospective Payment System (IPPS) minus the multifactor
productivity adjustment of 1.0 percentage points and minus a 0.1
percentage point adjustment, both of which are required by the
Affordable Care Act.
The final rule also provides a payment adjustment for designated
cancer hospitals as required by the Affordable Care Act. This
payment adjustment is expected to increase payments to cancer
hospitals by 11.3 percent (or approximately $71 million) over
what they would have otherwise been paid.
In response to concerns that Medicare’s requirement for direct
physician supervision of outpatient hospital therapeutic
services could hinder access for beneficiaries specifically in
rural areas, the final rule establishes an independent advisory
review process to consider requests that specific outpatient
services be subject to a level of supervision other than direct
supervision. Under this process, CMS will seek recommendations
from Ambulatory Payment Classification (APC) Advisory Panel
about appropriate supervision requirements. This panel was
created to provide technical advice and recommendations to CMS
about assigning items and services furnished in hospital
outpatient departments to appropriate payment classifications.
CMS will add two small rural PPS hospital members and two CAH
members to represent their interests to the Panel so that all
hospitals subject to the supervision rules for payment of
outpatient therapeutic services will be represented. Since CAHs
are not paid under the OPPS, CAH representatives would not
participate in deliberations about APC assignments.
“The CMS is committed to ensuring that beneficiaries who are
treated in small rural hospitals have access to high quality,
safe therapeutic services in outpatient departments,” said
Jonathan Blum, deputy administrator and director for CMS’s
Center for Medicare. “We believe the process we have adopted
will provide meaningful and transparent input from stakeholders
to assist CMS in establishing appropriate supervision
requirements.”
In other provisions, the final rule will:
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Pay for the
acquisition and pharmacy overhead costs of separately
payable drugs and biologicals, other than new drugs and
biologicals that have pass-through status, at the average
sales price (ASP) plus 4 percent.
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Pay for
partial hospitalization (PHP) services in hospital-based
PHPs and community mental health centers (CMHCs) based on
the unique cost-structures of each type of program. For both
types of providers, CMS is proposing to finalize our
proposal to update the four PHP per diem payment rates based
on the median costs calculated using the most recent claims
data for each provider type.
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Increase
the number of measures for reporting in CY 2012 and CY 2013
for purposes of the CY 2014 and CY 2015 payment
determinations, and would modify the process for selecting
hospitals for validating reported chart-abstracted measures
that was adopted for CY 2012 in the CY 2011 OPPS rule.
Provisions affecting payments to
Ambulatory Surgical Centers
The final rule increases payment rates to ASCs by 1.6 percent in
CY 2012. This reflects a consumer price index for all urban
consumers estimated at 2.7 percent, minus a 1.1 percent
productivity adjustment required by the Affordable Care Act.
The final rule also establishes a quality reporting program for
ASCs and adopts five quality measures, including four outcome
measures and one surgical infection control measure beginning in
CY 2012 for the CY 2014 payment determination. The final rule
adds two structural measures for reporting beginning in CY 2013
for the CY 2015 and CY 2016 payment determinations – one for
safe surgery checklist use, and one for ASC facility volume data
on selected ASC surgical procedures.
Provisions affecting the Hospital Value-Based
Purchasing program
The Hospital VBP, which was required by section 3001(a) of the
Affordable Care Act, was initially established in a final rule
published in May 2011. The final rule contained the measures,
performance standards, and scoring methodology that would be
used to determine the value-based incentive payments to
hospitals in FY 2013. The final rule announced today addresses
the program requirements for the FY 2014 program. These changes
include: adding one clinical process measure to guard against
infections due to urinary catheters; and, establishing the
weighting, performance periods, and performance standards for
the clinical process, patient experience, and outcomes measures
for FY 2014.
The final rule with comment period for the OPPS and the ASC
payment system can be downloaded from:
http://www.ofr.gov/inspection.asp
It will appear in the Nov. 30, 2011, Federal Register. CMS will
accept comments on issues open for comment by Jan. 3, 2012, and
will respond to them in the CY 2013 rule.
The Addenda to the final rule for the OPPS are available at:
http://www.cms.gov/HospitalOutpatientPPS
The Addenda to the final rule for the ASC payment system are
available at:
http://www.cms.gov/ASCPayment
A CMS fact sheet (11/1/11) providing more details on the final
rule can be found at:
http://www.cms.gov/apps/media/press/factsheet.asp?Counter=4145
Support Disaster Relief with the AHIMA Foundation
The AHIMA Foundation has established the Health Information
Relief Operation (HIRO) fund to provide support to health
information professionals when disaster strikes. The first and
most immediate need is to help victims of the recent tornados in
Joplin, MO; Alabama; and Mississippi. Please consider donating
today.
Learn more |
Donate Online For information on donating to the Alabama Tornado Relief Fund
please visit the American Red Cross website at
www.redcross.org
If donating by check please send to:
American Red Cross
Mid Alabama Region
300 Chase Park South
Hoover, AL 35244
**note “Alabama Tornado” in memo line
If donating by credit card please
click here.
**You will have the option to click on the Mid Alabama Region.
For information on donating supplies to the Alabama Tornado
Relief Fund please visit the Christian Service Mission website
at www.csmission.org. Click on
amazon.com to start shopping.
If you prefer to mail supplies, ship to the address below.
Christian Service Mission - Disaster Relief
3600 3rd Ave. South
Birmingham, AL 35222
Alabama Uniform Power of Attorney Act
The Alabama Uniform Power of Attorney Act
bill, AL H 26, was pre-filed 2/25/11 by Representative B.
Poole. This bill provides definitions and applicability of
the power of attorney, provides for when a power of attorney
is durable, provides for the execution, validity, meaning,
effect and termination of a power of attorney and provides
for the nomination of a conservator or guardian. The full
bill can be viewed at
http://alisondb.legislature.state.al.us/acas/ViewPrefiledBillsACASLogin.asp
Click “Get Firsts” button, select HB 26 then click “View”
tab at top of screen.
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