Mixed bag for rads in 2010 HOPPS proposals

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The Centers for Medicare & Medicaid Services (CMS) released the review copy of the 2010 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule on July 1. According to the American College of Radiology (ACR), several of the CMS proposals in this document, if approved, will affect the practice of both radiology and radiation oncology.

Some of these proposals--or lack of proposals--that are currently under review by the ACR are:

  • Effective Jan. 1, 2010, the conversion factor for HOPPS will be $67.439, a slight uptick from the current 2009 conversion factor of $65.684.
  • CMS is not proposing any new composite ambulatory payment categories (APCs) for 2010, so that they may monitor the effects of the existing composite APCs on utilization and payment.
  • In 2010, CMS will pay for separately payable drugs and biologicals under the OPPS at the average sales price (ASP) plus 4 percent.
  • CMS is not proposing to pay separately for radiation therapy guidance services provided in the treatment room for 2010, which would be consistent with the APC panel's recommendation.
  • The packaging threshold for drugs and biologicals will be $65 for 2010, a $5 increase from the current threshold of $60 for 2009.
  • CMS is proposing to continue pass-through status in 2010 for 31 drugs and biologicals at an ASP of plus 6 percent, equivalent to the rate the drugs and biologicals would receive in the physician's office.
  • CMS is proposing to pay for brachytherapy sources based on median unit costs, as calculated from claims data according to the standard OPPS rate-setting methodology.
  • CMS is proposing to continue to require hospitals participating in HOP Quality Data Reporting Program (QDRP) to report the existing seven chart-abstracted emergency department and peri-operative measures, and four existing claims-based imaging efficiency measures for the HOP QDRP for CY 2011 payment determination.
  • CMS is proposing to revise or further define several current policies for the physician supervision of outpatient services. First, CMS is proposing that non-physician practitioners, specifically physician assistants, nurse practitioners, certified nurse specialists, and certified nurse-midwives, may directly supervise all hospital outpatient therapeutic services that they are able to personally perform within their state scope of practice and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.

The ACR said it will be submitting comments addressing issues of concern to CMS by its deadline of Aug. 31.