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  • CMS Outpatient Payment Proposed Rule Addresses Opioids, Hospital-Owned Off-Campus Facilities

    The proposed outpatient prospective payment system (OPPS) rule recently released by the Centers for Medicare and Medicaid Services (CMS) includes payment increases, but the provisions getting the most attention are one designed to decrease opioid prescribing and another that will move certain off-campus hospital-owned outpatient departments out of the OPPS payment system.

    Here are a few highlights from the proposed rule.

    Patient satisfaction survey questions about pain management will be eliminated.
    In the midst of an opioid abuse epidemic that has gained national attention, CMS has announced a proposal that would eliminate questions about pain management from the patient satisfaction surveys used in its value-based purchasing programs. It's a move that CMS is taking after it received feedback that the pain management questions may "[create] pressure on hospital staff to prescribe more opioids in order to achieve higher scores on this dimension," according to a fact sheet from CMS.

    "Although CMS is not aware of any scientific studies that support an association between scores on the pain management dimension questions and opioid prescribing practices, we are proposing to remove [the questions] in an abundance of caution," CMS states, adding that alternate questions are being developed for future use.

    Hospital-owned off-campus outpatient departments won't be getting paid through OPPS.
    The second notable change in the proposed rule—the removal of hospital-owned, off-campus outpatient departments from the OPPS—was less of a surprise, given that Congress mandated CMS to do something about the issue when it passed the budget in 2015. The proposal will have minimal effect on physical therapists (PTs).

    The change is intended to curb what Medicare sees as a pattern of hospitals buying up off-campus physician offices to receive the higher rates associated with OPPS. Congress picked up on the issue when it approved the Bipartisan Budget Act of 2015 and directed CMS to place these facilities "under the applicable payment system." For now, that payment system would be the Medicare physician fee schedule, a "transitional policy" that CMS intends to use in 2017 while it explores other options for payment. CMS estimates that the change will reduce OPPS spending by about $500 million in 2017. Because PT services already are billed under the physician fee schedule, PTs will not feel the change directly.

    While the proposal was met with criticism from the American Hospital Association and other hospital trade groups that claim the change would be a disincentive for hospitals to create new outpatient facilities, CMS sees the change as one that will help to ensure that the program and its beneficiaries "do not pay more for care simply because of the setting in which that care was received," according to a CMS press release. Exceptions to the change would be made for certain services, including those delivered in a dedicated emergency department.

    EHR reporting requirements are changing, and PTs should start paying attention.
    Another important consideration: CMS plans to update electronic health records (EHR) reporting requirements to give hospitals greater flexibility in participating in the EHR incentive program. Under the proposed rule, CMS will implement a 90-day EHR reporting period to reduce administrative burdens on hospitals. The change is worth noting, because even though PTs have been exempt from meaningful use requirements in the past, these requirements will come into play once PTs begin participation in the Merit-Based Incentive Payment System in upcoming years.

    Payment is up for hospitals and ambulatory surgical care.
    As for payment, the proposed rule contains an anticipated 1.6% payment increase for hospitals paid under OPPS in 2017, with ambulatory surgical care centers slated for a 1.2% increase. The proposal also includes refinements to packaging of ancillary services, new policies for device-intensive procedures, and changes to partial hospitalization rate-setting.

    APTA will submit comments to the proposed rule, which are due by September 6.


    • The required hypervigilance of pain perception in the hospital setting is misguided and largely ineffective. It has caused increased focus on pain with little to no improvement in the actual "treatment" of the pain perception. It is tragic that this is only now being changed due to the intense focus on opioid and prescription pain medicine abuse. If CMS were progressive they would have understood the absurdity of their focus on pain control.

      Posted by Craig Vecchiarelli on 7/13/2016 10:25 PM

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