The Centers for Medicare & Medicaid Services (CMS) released a proposed rule1 on July 1, 2011, that would, beginning January 1, 2012, increase payments to hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) and implement the reporting of certain quality measures. The proposed rule purportedly seeks to promote higher quality and more efficient services for Medicare beneficiaries.
For HOPDs, the proposed rule would increase payments by 1.5 percent for 2012. CMS projects that it will pay more than 4,000 hospitals approximately $41.9 billion in 2012 for HOPD services. Cancer hospitals would receive the highest adjustment, approximately a 9 percent increase, with the projected increase in payments for non-cancer hospitals estimated to be 1.1 percent after all adjustments are taken into account.
For ASCs, the proposed rule would increase payment rates by 0.9 percent for 2012. CMS projects that its payments to the approximately 4,000 Medicarecertified ASCs will be approximately $3.61 billion in 2012. The difference in the percentage increase between HOPDs and ASCs is related, in part, to the methodology utilized to calculate the increases—for HOPDs, CMS uses the market basket update; for ASCs, CMS uses the consumer price index for all urban consumers.
Currently, HOPDs are required to report certain quality data under the Hospital Outpatient Quality Reporting Program. The proposed rule would add nine quality measures to the current list of 23 measures to be reported by HOPDs, resulting in a total of 32 measures for reporting. For the first time, CMS is proposing to implement a quality reporting program for ASCs. Beginning in January 2012, ASCs would report certain quality information that will be utilized by CMS to set payment rates beginning in 2014. For the 2012 reporting period, the quality measures would include seven outcome and surgical infection control measures and one healthcare associated infection measure.2 CMS proposes to expand the quality measures in subsequent years.
CMS will accept comments on the proposed rule until August 30, 2011. A final rule is expected to be issued in November.