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CMS Finalizes Hospital OPPS and ASC Payment Changes for 2013

November 2, 2012—The Centers for Medicare and Medicaid Services (CMS) Nov. 1 released its final rule with comment period, which 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. 

In the final rule, CMS updated hospital base payments by an increase factor of 1.8 percent.  This update reflects an inflationary increase of 2.6 percent minus a 0.7 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 finalized the agency’s proposal not to add any new quality measures for the Outpatient Quality Reporting Program (OQR) in CY 2015. CMS will also delay the data collection and reporting of two previously finalized measures, and will remove an additional measure from public reporting.  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 [see Washington Highlights, Nov. 4, 2011].

Under the CY 2013 final rule, CMS will 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 receive currently and is equivalent to the rate these drugs and biologicals will receive in the physician’s office setting in CY 2013.

CMS also finalized a proposal to base outpatient relative payment weights on geometric mean costs rather than on median costs.  For outlier payments, CMS decided to maintain the fixed-dollar outlier threshold at the CY 2012 rate of $2,025 for CY 2013, rather than increase it to $2,400 as proposed.


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