CMS proposes pay bump for outpatient care

Proposal would boost outpatient reimbursements by 2.1%

CMS last week released prospective Medicare payment rules for 2015, proposing a 2.1% hike in outpatient visit reimbursements for hospitals and a 1.2% increase for ambulatory surgery centers.

Last year: CMS to pay flat rate for hospital outpatient clinic visits—regardless of severity

The increased hospital payment rates were calculated based on a 2.7% market-basket increase, subtracting a 0.4% productivity adjustment and a 0.2% cut required by the Affordable Care Act. The surgery center increase reflected a 1.7% adjustment to the consumer price index, minus a 0.5% productivity adjustment.

Under the proposal, specific rural community hospitals would continue to receive higher payments. Meanwhile, hospitals that do not meet certainly outpatient quality reporting requirements would have their reimbursements reduced by 2%.

Increase your outpatient business with new ambulatory data

In addition, CMS proposed a bundled payment rate for ancillary services that have average costs of $100 or less. Services that would not be included in the bundled payments are:

  • Certain psychiatric-related services;
  • Drug administration-related services; and
  • Preventive services.

The rule would affect more than 4,000 hospitals and 5,300 ambulatory surgery centers. CMS estimated that it would pay hospitals nearly $56.5 billion under the proposed rules in 2015, up by $5.2 billion over 2014 payments. Meanwhile, ambulatory surgery centers would receive about $4.1 billion in Medicare payments in 2015, a $243 million increase over 2014.

CMS will accept comments on the proposed rules until Sept. 2. It is expected to release final regulations around Nov. 1.

How to reimburse care for patients with two chronic conditions

Meanwhile, CMS in a separate proposal said it will provide details for payments for physicians caring for Medicare patients with at least two chronic conditions, which it had finalized last year. CMS proposed that such payment changes go through the public notice and comment process before being implemented. The agency said it will aim to have a procedure for the policy ready for 2016.

The physician payment proposal will be published in the Federal Register on July 11. CMS will accept comments on the rule until Sept. 2 (Herman, Modern Healthcare, 7/3 [subscription required]; Young, CQ HealthBeat, 7/3 [subscription required]).


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