Medicare announces larger-than-expected outpatient pay bump

CMS on Friday released close to 3,000 pages of regulations that finalized payment rules for different Medicare providers and services for 2015.

Among other rules, CMS created new payments for chronic care management programs, launched efforts to streamline payments for individuals' hospital care, and expanded the agency's Physician Compare website. CMS Administrator Marilyn Tavenner said the "rules are a part of a broader strategy driving greater value in health care."

CMS increases hospital outpatient, surgery center payments

CMS in the rules said it will increase Medicare payments for hospital outpatient services and ambulatory surgical centers (ASC) in 2015. Effective Jan. 1, 2015:

  • Hospital outpatient departments will receive a 2.2% bump in reimbursement rates; and
  • ASC's payment rates will increase by 1.4%.

The increase will affect more than 5,300 ambulatory surgical centers and 4,000 hospitals, according to Modern Healthcare. The increases are higher than those proposed by CMS earlier this year. The agency did not include estimates of how much the increases are expected to cost.

Increase your outpatient business with new ambulatory data

Changes to the Medicare Shared Savings Program

The rules also broaden quality performance penalties for all physicians and include additional quality criteria for the Medicare Shared Savings Program (MSSP). Specifically, Medicare physician payments beginning in 2015 will be adjusted based on quality performance measures and penalties will no longer apply solely to larger physician practices.

Are the ACOs near you improving care?
CMS releases site-specific quality data

Meanwhile, the ACOs taking part in the MSSP will be subject to 33 adjusted quality requirements, including:

  • Measures for patient stewardship resources;
  • Readmissions to 30-day, all-cause skilled nursing facilities; and
  • Unplanned, all-cause admissions for individuals with diabetes, heart failure and more than one chronic condition.

Additional regulations

CMS also finalized rules that, beginning in January, will:

  • Establish new quality and performance care standards for patients undergoing dialysis treatments;
  • Require Medicare to use competitive bidding rates to purchase durable medical equipment.
  • Allow physicians to bill Medicare $40.39 per month for each patient with more than one chronic condition to improve care quality;
  • Expand coverage for telehealth physician visits by requiring Medicare to reimburse physicians for wellness and behavioral health visits; and
  • Eliminate a "narrative" requirement that requires physicians to submit written descriptions explaining why home health services are necessary.

CMS also announced in the regulations that it will consider whether to reimburse providers for end-of-life care counseling, AP/Modern Healthcare reports. The potential payment changes would take effect in 2016 and would apply to voluntary end-of-life care counseling (Viebeck, The Hill, 10/31; Herman, Modern Healthcare, 10/31 [subscription required]; Young [1], CQ HealthBeat, 10/31 [subscription required]; Evans, Modern Healthcare, 10/31 [subscription required]; Young [2], CQ HealthBeat, 10/31 [subscription required]; Morgan, Reuters, 10/31; Young [3], CQ HealthBeat, 10/31 [subscription required]; AP/Modern Healthcare, 11/1).

How outpatient payments change next year


Join us for a Nov. 25 webconference, in which we will examine the final regulations for CY 2015 Hospital Outpatient and Ambulatory Surgical Center Payments, including standard updates to payment structure, payment amounts, and quality updates, and the broader implications of these changes.


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