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  • Washington Highlights

    CMS Releases CY 2017 OPPS Proposed Rule

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) July 6 released the calendar year (CY) 2017 Outpatient Prospective Payment System (OPPS) proposed rule updating payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2017. Comments on the rule are due Sept. 6, 2016.

    Among the most notable proposed changes are the implementation of Section 603 of the Bipartisan Budget Act (Pub. L. 114-74), the provision regarding site-neutral payments.  Other proposed changes include new classifications under the Ambulatory Payment Classification (APC) system and Value-Based Purchasing (VBP) program.

    The overall impact on major teaching hospitals is projected to be an average increase of 1.2 percent, compared to a 1.9 percent increase for non-teaching hospitals.

    CMS proposes to implement Section 603 of the Bipartisan Budget Act, including several proposals relating to which items and services will be permitted to be billed under OPPS. Items and services covered will be those furnished in dedicated emergency departments (EDs), hospital outpatient departments (HOPDs) that were billing under OPPS prior to Nov. 2, 2015, and HOPDs within 250 yards of a remote location of the hospital. CMS also proposes that, for HOPDs that were billing under OPPS as of Nov. 2, 2015, items and services in different “families of services” (defined in a chart provided by CMS) cannot be billed under OPPS. OPPS status can be transferred to new ownership only if the new owner accepts the existing Medicare provider agreement. If a provider based department (PBD) is relocated items and services provided there can no longer be billed under OPPS. Those items and services that cannot be billed under OPPS will be billed under the non-facility rate of the Medicare Physician Fee Schedule.

    Moving to a more prospective payment system, CMS also proposes to modify the comprehensive-APC (C-APC) policy by adding 25 new C-APCS, the majority of which are major surgery APCs.

    Additionally, under the Medicare Electronic Health Record Incentive Program, CMS proposes a 90-day reporting period in 2016 for all eligible physicians, eligible hospitals, and critical access hospitals (CAHs) to increase flexibility in the EHR Incentive Program.

    Regarding the quality provisions in the proposed rule, CMS proposes a significant change to how the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is scored under the VBP. Starting FY 2018, performance on the HCAHPS survey’s pain management dimension — which consists of three questions — would not count for payment purposes under the VBP program. The AAMC previously endorsed legislation that would delink the pain management questions from VBP payments [see Washington Highlights, April 29].

    CMS also proposes seven new measures to the Hospital Outpatient Quality Reporting (OQR) program starting CY 2020 payment determination: two claims-based measures assessing emergency department visits and inpatient admissions following chemotherapy and surgery and five Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey-based measures.