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CMS Proposes Hospital OPPS and ASC Payment Changes for 2013

July 13, 2012—The Centers for Medicare and Medicaid Services (CMS) July 7 posted on its website a proposed rule that contains changes to the calendar year (CY) 2013 outpatient prospective payment system (OPPS) as well as proposed payment rates for Ambulatory Surgical Centers (ASCs).  CMS will implement final changes to both the OPPS and the ASC payment system Jan. 1, 2013.  Comments on the proposed rule are due Sept. 4.

CMS proposes to update hospital base payments by an increase factor of 2.1 percent.  This update reflects an inflationary increase of 3.0 percent minus a 0.8 percentage point multifactor productivity adjustment and a 0.1 percentage point adjustment.  Both reductions are required by the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152).

CMS is proposing no new quality measures be added for the Outpatient Quality Reporting Program (OQR) in CY 2015. CMS proposes to delay the data collection and reporting of three previously finalized measures.  CMS will continue to allow hospitals the option of submitting quality data through the Electronic Reporting Pilot in order to satisfy meaningful use requirements, which was previously finalized in the CY 2012 OPPS rule.

Under the proposed rule, for CY 2013, CMS would pay for the acquisition and pharmacy overhead costs of separately payable drugs and biologicals without pass-through status at the average sales price (ASP) plus 6 percent.  This payment rate represents an increase of 2 percentage points from the rate these products currently receive and would be equivalent to the rate these drugs and biologicals would receive in the physician’s office setting in CY 2013.

CMS also proposes to increase the fixed-dollar outlier threshold from $2,025 in CY 2012 to $2,400 in CY 2013.


Jennifer Faerberg, MHSA
Director, Clinical Transformation Unit
Telephone: 202-862-6221


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806