CMS to raise hospital outpatient payments 3%

Jul 7, 2008

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a 3% increase in payments to hospitals and ambulatory surgery centers in an update of rates in its Outpatient Prospective Payment System (OPPS).

CMS said the rate increase represents an inflation update to the payments made to more than 4,000 hospitals and community mental health centers under the OPPS program. CMS projects that hospitals would receive $28.7 billion in calendar-year 2009 for outpatient services furnished to Medicare beneficiaries.

The changes also reflect CMS' new focus on tying payments to quality of care. The law now requires that the annual OPPS payment inflation update be reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements.

Hospitals must now report data in calendar 2008 on seven quality measures of emergency department and perioperative surgical care to receive the full OPPS payment update for services furnished in calendar 2009. CMS is proposing to add four new measures of imaging efficiency to the seven existing quality measures for purposes of the calendar 2010 update, the agency said.

CMS also plans to change how it pays for imaging services when multiple services are provided in one session, as part of an initiative to encourage greater efficiency. Under the proposal, CMS would make a single payment for multiple services of a particular type (such as multiple ultrasound procedures) performed in a single hospital session. In addition to ultrasound, CMS is proposing to apply this policy to CT and MRI services.

Comments on the proposed rule will be accepted until September 2, 2008, and a final payment rule will be issued by November 1.

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