The Centers for Medicare & Medicaid
Services (CMS) issued the Calendar Year (CY) 2014 Hospital Outpatient
Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment
System Policy Changes and Payment Rates proposed rule [CMS-1601-P] on July 8,
2013.
The proposed rule with comment
period would update Medicare payment policies and rates for hospital outpatient
department and ASC services, and update and streamline programs that encourage
high-quality care in these outpatient settings consistent with policies included
in the Affordable Care Act. Total CY 2014 OPPS payments are projected to
increase by $4.37 billion or 9.5 percent, and CY 2014 Medicare payments to ASCs
are projected to increase by approximately $133 million or 3.51 percent as
compared to CY 2013.
Overview
More than 4,000 hospitals, including
general acute care hospitals, inpatient rehabilitation facilities, inpatient
psychiatric facilities, long-term acute care hospitals, children’s hospitals,
and cancer hospitals are paid under the OPPS. There are approximately
5,000 Medicare-participating ASCs paid under the ASC payment system.
The OPPS is currently a hybrid of a
prospective payment system and a fee‑for‑service system, with some payments
representing costs packaged into a primary service and other payments
representing the cost of a particular item, service, or procedure.
Payment amounts vary according to the Ambulatory Payment Classification (APC)
group to which a service is assigned. The OPPS includes payment for most
hospital outpatient department services, and covers partial hospitalization
services furnished by hospital outpatient departments and community mental
health centers.
The CY 2014 OPPS/ASC rule proposes
to expand the categories of related items and services packaged into a single
payment for a primary service under the OPPS, in order to make the OPPS more of
a prospective payment system. When the OPPS began in 2000, the payment
system provided for the packaging of a limited number of items and services,
such as anesthesia and surgical supplies. CMS expanded the categories of
included items and services in 2008 and 2009, by adding eight additional
categories, including image processing services, and implantable
biologicals. This proposed rule would further expand the categories of
packaged items and services by adding seven additional categories of supporting
services, thereby moving the OPPS closer to a prospective payment system that
is more analogous to Medicare payment for hospital inpatient services and less
like a rate-for-service payment model. In addition to packaging these seven
categories, CMS is proposing to create 29 comprehensive APCs to replace 29
existing device-dependent APCs.
For the full Fact Sheet click here.
