CMS proposes 3% increase for hospital outpatient payments

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The Centers for Medicare & Medicaid Services (CMS) has a new proposed rule, including a 3 percent annual inflation update, which will update payment rates for calendar year (CY) 2009. CMS is seeking additional quality improvement measures from providers 

The agency is proposing to add four new measures of imaging efficiency to the seven existing quality measures for purposes of the CY 2010 update.

The proposed rule will update rates paid under both the outpatient prospective payment system (OPPS) and the ambulatory surgical centers (ASC) Prospective Payment System, which will be in the second year of a four-year transition that aligns ASC rates with the ambulatory payment classification groups, CMS said.

The agency said its proposed rule includes a 3 percent annual inflation update to Medicare payment rates for most services that would be paid under the OPPS to more than 4,000 hospitals and community mental health centers in CY 2009. The proposed changes would affect outpatient services furnished by general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, community mental health centers, children’s hospitals and cancer hospitals. 

CMS projects that hospitals would receive $28.7 billion in CY 2009 for outpatient services furnished to Medicare beneficiaries. Furthermore, CMS expects to make payments of almost $3.9 billion in CY 2009 to the approximately 5,300 ASCs that participate in Medicare.

CMS is also seeking public comment on eighteen additional potential quality measures in areas ranging from screening for fall risk to cancer care that are under consideration for future years.

“The changes proposed for 2009 are intended to give hospitals greater flexibility to manage their resources and give them incentives to improve efficiency so that both beneficiaries and taxpayers get the most value for their healthcare dollar,” said CMS Acting Administrator, Kerry Weems. 
“A key part of CMS’ value-based purchasing strategy is to link our payment to quality of care by providing incentives for hospitals to follow established guidelines and reduce the number of preventable conditions that occur as result of treatment,” said Weems.

Under the proposed rule, the amount beneficiaries will pay for outpatient services would continue to decline based on a formula in the Medicare law that is designed to provide a gradual transition to 20 percent coinsurance, the agency said.