On November 1, 2011, CMS posted a display copy of the final rule (with comment) governing payment policies for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs). The following are highlights from the final rule:
Payment Rate Changes
- The payment rate increase for HOPD services for calendar year (CY) 2012 will be 1.9 percent.
- ASC payments will be increased by 1.6 percent for CY 2012.
- IPPS-exempt cancer hospitals with a payment-to-cost ratio (PCR) for CY 2012 that is below the target PCR will receive an additional payment to ensure that final payment is equal to the target PCR. CMS estimates that this will result in an 11.3 percent increase in payments to cancer hospitals. The CY 2012 payment adjustment will be made via an aggregate payment at cost report settlement.
- CMS will pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status at the average sales price plus 4 percent.
- Updates the partial hospitalization program (PHP) Ambulatory Payment Classification (APC) rates for APC 0172, 0173, 0175, and 0176.
Evaluation of Supervision Levels for Outpatient Therapeutic Services
- Establishes a process to consider requests for changes to the level of supervision currently required for outpatient therapeutic services. Requests for changes will be referred to the Ambulatory Payment Classification Panel for an evaluation and recommendation.
Changes to Hospital Outpatient Quality Reporting Program
- Adds 3 quality measures to the current list of 23: (1) a chart abstracted measure about cardiac rehabilitation patient referral; (2) a structural measure about the use of a safe surgery checklist; and (3) a structural measure collecting hospital outpatient department volume for selected surgical procedures.
Changes to ASC Quality Measure Reporting
- Adopts five quality measures to be reported by ASCs beginning October 1, 2012, for CY 2014 payment determinations. The measures include four outcome and one surgical infection control measure.
- Adds two structural measures to be reported beginning in CY 2013 for the CH 2015 payment determination: safe surgical checklist use and ASC facility volume data on selected ASC surgical procedures.
- Adds one infection control measure to be reported beginning in CY 2014 for the CY 2016 payment determinations.
Hospital Inpatient Value-Based Purchasing Proposals for Fiscal Year 2014
- Adds one new clinical practice measure to the clinical process domain, to be applicable in FY 2014: whether a urinary catheter inserted during surgery is removed on the first or second day after surgery.
- Suspends the effective dates of the HAC, AHRQ, and Medicare Spending per Beneficiary measures; these measures will not be included in the FY 2014 Value-Based Purchasing program.
- For FY 2014, clinical process of care measures will constitute 45% of a hospital’s total performance score, the patient care experience of care domain will constitute 30%, and the outcome domain will constitute 25%.
- Discusses the review and correction process under which hospitals will have an opportunity to review and correct certain data.
Physician-Owned Hospital Expansions
- Explains the process for physician-owned hospitals to request an exception to the prohibition against expanding facility capacity.
The rule is scheduled to appear in the November 30, 2011 Federal Register. Comments must be received by CMS by January 3, 2012, and will be addressed in the CY 2013 rule. The full text of the final rule is available by clicking here.