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  • Washington Highlights

    AAMC Comments on 2022 Outpatient Prospective Payment System Proposed Rule


    Andrew Amari, Hospital Policy and Regulatory Specialist
    Mary Mullaney, Director, Hospital Payment Policies
    Phoebe Ramsey, Director, Physician Payment & Quality

    The AAMC submitted comments on Sept. 15 regarding the Centers for Medicare & Medicaid Services’ (CMS’) Calendar Year (CY) 2022 Outpatient Prospective Payment System (OPPS) proposed rule. In addition to its comments on the hospital payment and quality provisions, the AAMC’s letter also addresses updates to the mandatory Radiation Oncology Model [refer to related story].

    Below are highlights of the AAMC’s comments on the hospital payment and quality provisions in the proposed rule:

    Payment Provisions

    • 340B Drug Pricing Program: The CMS proposed to continue paying for separately payable drugs reimbursed under the OPPS and acquired through the 340B program at average sales price minus 22.5%. The AAMC urged the CMS not to continue the reimbursement reductions for 340B-acquired drugs and requested that the agency provide greater transparency in how it calculates and implements the budget neutrality adjustment.
    • Data Sources for Ratesetting: The CMS proposed to use data sources from CY 2019, or CY 2018 where applicable, for CY 2022 OPPS ratesetting. The AAMC supported the use of CY 2019 data as a better overall approximation of expected CY 2022 hospital outpatient services.
    • Inpatient Only (IPO) List: The CMS proposed to halt the elimination of the IPO list and return all 298 services that were removed in the CY 2021 OPPS final rule to the IPO list, beginning in CY 2022. The AAMC urged the CMS to finalize its proposal to halt the elimination of the IPO list and suggested that the CMS work with stakeholders as part of a continuous evaluation process to determine which procedures and treatments are shown to be safely and successfully performed in the outpatient setting.
    • Site-Neutral Payment Policy: The CMS proposed to continue the payment reductions for clinic visits (Healthcare Common Procedure Coding System [HCPCS] code G0463) when furnished in excepted off-campus provider-based departments in CY 2022 and beyond. The AAMC urged the CMS not to continue its site-neutral payment reductions in CY 2022 and beyond.
    • Hospital Price Transparency: The CMS proposed to increase civil monetary penalties (CMPs) for hospitals’ noncompliance based on a hospital’s bed count, as documented on the hospital’s cost report. The AAMC urged the CMS not to finalize new CMPs for hospitals viewed as noncompliant with price transparency requirements.
    • Medicare Wage Index: The CMS proposed to continue its policy to raise wage indexes of low-wage hospitals. The AAMC supported the agency’s continuation of the low wage index policy for the CY 2022 OPPS wage index and also urged the CMS to extend the 5% transitional cap in CY 2022 to all hospitals given the unique impact the COVID-19 public health emergency continues to have on both hospital finances and area wages.  
    • Ambulatory Surgical Center Covered Procedures List (ASC-CPL): The CMS proposed to reinstate the general standards and exclusion criteria in place prior to CY 2021 for adding procedures to the ASC-CPL, remove 258 of the 267 procedures added to the list in CY 2021, and establish a nomination process for adding procedures to the list. The AAMC supported finalizing the agency’s proposed nomination process, as well as the reinstatement of the general standards and exclusion criteria, which provide critical patient safety protections.
    • Payment for COVID-19 Specimen Collection: The CMS requested comments on whether payment for COVID-19 specimen collection under the OPPS (HCPCS code C9803) should be made permanent. The AAMC strongly supported making payment for COVID-19 specimen collection under the OPPS permanent to facilitate testing for COVID-19.
    • Direct Supervision by Interactive Communications Technology: The CMS solicited comments on whether it should permanently allow direct supervision for select rehabilitation services to meet through two-way, audio/video communication technology. The AAMC supported permanently allowing hospitals to meet direct supervision through interactive telecommunications technology for select rehabilitation services, which enables hospitals to safely and flexibly provide the select rehabilitation services.
    • Mental Health Services Furnished Remotely by Hospital Staff: The CMS solicited comments on the extent to which hospitals have been billing for mental health services provided to beneficiaries in their homes through communications technology during the public health emergency — and whether hospitals would anticipate a continuing demand for this model of care following its conclusion. The AAMC supported making permanent these flexibilities permitting hospital staff to remotely provide mental health services furnished to beneficiaries in their homes.

    Quality Provisions

    • Adoption of New Measures and Modifying Existing Measures for the Outpatient Quality Reporting (OQR) Program: The CMS proposed to adopt three new quality measures and modify two existing patient survey-based measures in the OQR program. Regarding the COVID-19 vaccination among health care personnel measure, the AAMC believes that the CMS should address outstanding questions that directly impact the design and feasibility of the measure in advance of its inclusion in the program. The AAMC supported measurement of patient experience in the outpatient setting and encouraged the CMS to monitor responses rates regarding new web-based survey modes proposed for the outpatient Consumer Assessment of Healthcare Providers and Systems (CAHPS).
    • Potential Efforts to Address Health Equity in the Hospital OQR Program: The CMS requested feedback on how it could address health disparities through its quality reporting programs. The AAMC suggested that the CMS work with stakeholders to improve data collection to better measure and analyze disparities in a manner that builds an evidence-based, valid, and reliable framework toward provider accountability for health equity. The AAMC responded that the CMS should pursue a policy supporting the collection of standardized multisector risk information that will aid improved stratification and risk adjustment beyond individual-level demographic data elements. Data collection and systems for capturing unmet social need at the individual and community levels should be used in conjunction to best identify disparities in quality and equity to guide interventions for improvement. The AAMC reiterated prior comments in response to the fiscal year 2022 Inpatient Prospective Patient System proposed rule [refer to related story] that the agency should encourage the reporting and use of actionable data on health-related social needs instead of using statistically imputed estimates of race and ethnicity to stratify reporting, in part because race and ethnicity themselves are not risk factors and reliance on immutable characteristics alone is not informative for intervention.
    • Advancing Digital Quality Measurement: The CMS solicited feedback to inform future rule-making on the agency’s goal of transitioning to digital quality measurement in its quality reporting and performance programs by 2025. The AAMC suggested that the CMS refine its definition of digital quality measures to focus first on currently available valid and reliable digital data sources, set clear and specific parameters for what the agency hopes to achieve, and make clear what it expects of hospitals as it aims to transition to digital quality measurement by 2025.