The AAMC Sept. 24 submitted comments on the Centers for Medicare and Medicaid Services (CMS) Outpatient Prospective Payment System (OPPS) calendar year (CY) 2019 proposed rule. In addition to the standard payment updates, CMS proposed to expand its site-neutral payment policy, expand the 340B drug payment policy cuts to nonexcepted provider-based departments (PBDs), limit expansion of clinical families of services at excepted off-campus PBDs, and modify payments for wholesale acquisition cost and average sales price drugs and biologics. CMS also proposed changes to several quality measures.
In the proposed rule, CMS contends that there has been an “unnecessary increase” in the volume of services in hospital outpatient departments (HOPDs) and off-campus PBDs compared to physician offices. The AAMC disagrees with that assertion. The association’s comment letter notes that the shift of services to outpatient settings is caused by a confluence of factors. They include both growth in the Medicare population and increases in the number and variety of prescription drugs used in treatment – in addition to CMS’s policy changes to drive health care services to lower-cost outpatient settings. Furthermore, continued reductions in Medicare payments to providers for medically necessary services and prescription drugs likely will have a negative impact on beneficiaries’ health and access to care.
Highlights of the AAMC’s comment letter include:
Site-Neutral Expansion: CMS has proposed to expand its site-neutral payment policy to pay outpatient clinic visits at a physician fee schedule (PFS) equivalent rate, which is 40% of the OPPS rate, to control for “unnecessary increases in volume of services” in HOPDs. The AAMC questions CMS’s authority to impose this payment reduction and urges CMS not to finalize the proposal.
340B Reductions Expansion: CMS has proposed to expand reimbursement reductions for 340B-acquired drugs administered in off-campus PBDs. Under the proposal, drugs acquired under the 340B program will be reimbursed at average sales price minus 22.5% or wholesale acquisition cost minus 22.5%. The AAMC opposes these proposals and recommends that CMS not finalize them, as the 340B program has been unfairly and inaccurately targeted as the cause of high drug prices and any reductions only harm the patients and programs that rely on programs support by 340B savings.
Clinical Families of Services: CMS proposed to pay excepted off-campus PBDs a reduced, PFS-equivalent rate for items and services that are not within a clinical family from which the provider furnished items or services during a defined baseline period. The AAMC opposes the proposal and asks CMS to not finalize it, as it both limits affected providers’ flexibility to meet the needs of their patient populations and would create significant burden for providers to ascertain which clinical families they furnished during the baseline period.
Quality Measure Removals: CMS has proposed to remove one measure from the Hospital Outpatient Quality Reporting Program beginning in CY 2020 and nine measures in CY 2021. The AAMC supports CMS’s proposal to remove measures that are burdensome or otherwise do not meet the goals of CMS’s Meaningful Measures framework and recommends that CMS continue to remove additional measures that are similarly situated.
HCAHPS “Communications About Pain” Questions: CMS proposed to update the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measure by removing the “Communications About Pain” questions. The AAMC suggests that rather than remove the questions entirely, CMS should continue to test the questions and delay public reporting until the questions are valid, reliable, and do not pose a risk of unintended consequences.
Conditions of Participation: CMS proposed to create additional conditions of participation (CoPs) to promote interoperability and the exchange of electronic health information. The AAMC notes that CMS should not include a requirement for interoperability in the CoPs given the significant consequences if the requirements are not met.