The Centers for Medicare and Medicaid Services (CMS) released its proposed 2019 Medicare Hospital Outpatient Prospective Payment System rule (OPPS) at the end of July. The proposed rule included three proposed changes that would dramatically and negatively affect hospital reimbursement:
- Site-neutral reimbursement for outpatient clinic visits in all off-campus provider-based departments (PBDs) at 40 percent of the OPPS rate regardless of whether those departments are excepted under the Bipartisan Budget Act of 2015;
- Reductions in payment amounts for separately payable 304B drugs furnished in off-campus PBDs regardless of whether those departments are excepted (subject to exceptions for children's hospitals and certain rural and cancer hospitals); and
- Limitations on the ability of excepted off-campus PBDs to add new clinical families of services.
CMS estimates that the proposed site-neutrality change alone would reduce Medicare spending and beneficiary co-insurance payments by $760 million in 2019.
Comments to these proposals are due to CMS by September 24, 2018. If hospital providers have not done so, now
is the time to assess the potential financial impact of the proposed rule and to prepare comments to CMS explaining the same.