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  • Proposed CMS Outpatient Rule Would Adopt Further 'Site Neutral' Payment Policies

    Should Medicare be reimbursing outpatient facilities owned by hospitals at higher rates than it does independent providers' facilities? The US Centers for Medicare and Medicaid (CMS) doesn't think so.

    In its 2019 outpatient prospective payment system (OPPS) rule, CMS proposes to expand its use of a "site-neutral" payment model in its reimbursements, meaning that it will do away with the current system that pays so-called "off-campus" hospital-owned facilities an estimated $75 to $85 more than it does independent counterparts. The proposal is expected to meet with opposition from hospital groups.

    If adopted, CMS estimates the change will save Medicare around $760 million in 2019, according to a CMS fact sheet on the proposed rule. Those savings would help to offset an overall payment increase of 1.25%, or about $4.9 billion.

    "This proposal indicates that CMS is aware of, and taking action against, the potential for rising costs due to the consolidation of health care systems," said Kate Gilliard, APTA's senior regulatory affairs specialist. "By implementing site-neutral payments, major health systems will be less incentivized to buy up smaller practices, because they won't be receiving a higher reimbursement rate for the mere fact that they are owned by a hospital system."

    Also included in the proposed OPPS:

    • Ambulatory surgical center (ASC) payment would increase by 2% and would be updated based on the hospital market basket update instead of the "consumer price index-urban all item" (CPI-U) system through at least 2023.
    • Nonopioid pain-management drugs that function as a supply when used in an ASC surgical procedure would be paid for separately.
    • CMS is soliciting comments on regulatory changes that might help prevent opioid use disorders and improve access to treatment in the Medicare program, as well as identify any barriers that may inhibit access to non-opioid alternatives for pain treatment and management.

    APTA is analyzing the proposed rule and will provide comments to CMS by the September 24 deadline.

    Comments

    • Please let me (us all) know how to help in advocacy for this.

      Posted by John Baio on 7/31/2018 11:14 PM

    • Patients deserve some level of transparency when it comes to billing. We should not be doubling the price of a daily visit simply because a hospital has taken over the billing. Site-neutral payments are a necessity!

      Posted by John Earls on 8/1/2018 7:26 AM

    • Now if we could just get the other insurance companies to do the same. This is the reform that is needed. With commercial insurance the difference can be closer to a $200 - $300 increase over what they pay private practices.

      Posted by Barbara Bobyett on 8/1/2018 6:48 PM

    • I am guessing that they are lowering the hospital rate instead of averaging the right and raising it for us lowly outpatient ortho PT sites. Cynical me!

      Posted by Robin Ryan on 8/1/2018 7:43 PM

    • It’s about time! Talk about unfair playing ground for years. Hospital monopolies having been throwing their weight around for long enough without consequence. Why should the Independent Contractor be penalized for doing the same work for lower pay?!?! My bet is that the Hospital lobbyists prevent this from happening. Let’s sit back and watch?

      Posted by Mark Waldrop on 8/2/2018 6:14 AM

    • Hmm...so now ALL outpatient clinics will have techs/aides doing 90% of the treatments instead of actual licensed staff. Shame on us for still trying to call this 'skilled care' in the name of making more money. No wonder they keep paying us less, we deserve it for way over-utilizing techs/aides in patient care. We will never prove our 'skill' practicing this way.

      Posted by Angela Brand on 8/2/2018 10:59 AM

    • This is a positive step in creating equity among providers. I presently am a partner in a private practice and previously managed in an outpatient hospital clinic. While both offered great care, my private practice affords greater ability to trailer care to the individual patient. As far as the post by Angela, we do not employ techs and have 100% care provided by Licensed staff. This is true of the majority of the private practices in my area.

      Posted by Josh on 8/4/2018 2:47 PM

    • Finally! Private practice owners have suffered under this system for so many years. There seems to be NO awareness of the issue in the general public, and until now, no action to change it. As hospitals buy up the physicians, we see our referrals instantly vanish, as hospitals keep everything in house. With hospitals being reimbursed up to 2-3 times what we are being paid, they can offer better pay and benefits, and we lose our therapists to them as well. It has been such an uneven playing field for private practices. I hope to see CMS do the right thing and commercial insurance companies follow.

      Posted by Teri Maciejewski on 8/4/2018 3:18 PM

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