On July 18, CMS published a proposed rule governing hospital outpatient prospective payments, ambulatory surgical center (ASC) payments and hospital value-based purchasing (VBP) program measures for CY 2012. Highlights of the proposed changes contemplated by the rule follow below.

Hospital Outpatient Rate Increases

The 2012 outpatient department fee schedule for hospital outpatient departments, other than cancer hospitals, will increase by 1.1 percent for CY 2012 for hospitals reporting quality data. Hospitals that do not report quality data will experience a 0.9 percent decrease. CMS computed the rate by using a market basket increase of 2.8 percent plus a 0.2 percent increase to maintain budget neutrality for community mental health center partial hospitalization rate changes less a productivity adjustment and a minor adjustment to comply with PPACA and a 0.6 percent reduction to ensure that the proposed cancer hospital payment adjustment will be budget neutral.

CMS proposes to adjust the outpatient department fee schedule payments to cancer hospitals in 2012 for cancer hospitals with a payment-to-cost ratio that is below the weighted average of other cancer hospitals. The aggregate net payment increase to cancer hospitals for 2012 is estimated to be approximately nine percent.

Finally, ASC payments will increase by 0.9 percent for 2012.

Outpatient Therapy Supervision

A process for providers to submit requests for changes in the minimum required level of supervision is being proposed for individual outpatient therapeutic services.

Quality Measures

CMS plans to add nine quality measures to the current list of 23 being reported by hospital outpatient departments, thus bringing the total number of measures to be reported in 2012 for determining payment in 2014 to 32. These new quality measures include:

  • National Healthcare Safety Network Healthcare Associated Infection Measure for Surgical Site Infection;
  • Five diabetes care chart-abstracted measures;
  • Cardiac rehabilitation patient referrals from outpatient settings based upon chart-abstracted data;
  • Use of a safe surgery checklist; and
  • Hospital outpatient department volume for selected surgical procedures.

The agency also proposes applying new weights to the four quality domains for 2014. Additionally, changes to the Electronic Health Record Incentive Program addressed by the proposed rule include allowing hospitals to continue reporting clinical quality measures via attestation or, alternatively, participate in a proposed Electronic Reporting Pilot program.

Quality measures added to ASC payment determinations for 2014 based on data from a 2012 reporting period include (1) patient fall in the ASC; (2) patient burn; (3) hospital transfer/admission; (4) wrong site, side, patient, procedure or implant; (5) prophylactic IV antibiotic timing; (6) appropriate surgical site hair removal; (7) selection of prophylactic antibiotic -- first or second generation cephalosporin; and (8) surgical site infection rate. Quality measures based on the use of a safe surgery checklist and volumes of selected surgical procedures would be added for 2015.

CMS also proposes adding a measure for influenza vaccination coverage among healthcare personnel to the payment determinations for hospital outpatient departments in 2015 and for ASCs in 2016.

Hospital Value-Based Purchasing Changes

Under the VBP program, CMS will make value-based incentive payments to hospitals that meet certain performance standards for discharges occurring on or after October 1, 2012. A new measure will be added to the existing list of 13 hospital VBP measures for the timely removal of urinary catheters post surgery. New domains for efficiency and outcomes will expand the total number of domains from two to four.

For 2014 payment determinations, CMS plans to adopt a nine-month performance period (April 2012 to December 2012) to measure the clinical process of care and patient experience of care domains and a seven-month performance period (March 2012 to September 2012) for hospital-acquired conditions and Agency for Healthcare Research and Quality measures.

For 2014, CMS proposes to weight the VBP measure domains as follows: outcome domain -- 30 percent; clinical process of care domain -- 20 percent; patient experience of care domain -- 30 percent; and efficiency domain -- 20 percent. For 2013, the clinical process of care domain's 12 measures are weighted 70 percent and the patient experience of care domain is weighted 30 percent.

Other Items of Note

The proposed rule includes provisions, which largely track the statutory language in PPACA, implementing the process for physician-owned hospitals to expand the number of beds, procedure rooms and operating rooms.

Finally, a proposal to reduce the types of outpatients who must be notified that the hospital does not have 24/7 on-site physician coverage was included. This proposal also would permit notice to be provided to emergency department patients through a conspicuous posting.