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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

At Hospital Outpatient Payment Panel, CMS Discusses Plans for CY 2015 Outpatient Rule

March 14, 2014—The Hospital Outpatient Payment (HOP) Panel met March 10 to discuss Medicare outpatient payment policies, including ambulatory payment classification (APC) groups and assignments, various codes and cost centers, and physician supervision requirements.

During the meeting, John McInnes, M.D., J.D., director, Division of Outpatient Care at the Centers for Medicare and Medicaid Services (CMS), reiterated CMS’s commitment to make the Medicare outpatient prospective payment system (OPPS) more of a prospective payment system rather than a fee schedule.

As steps toward this goal, Dr. Mclnnes suggested that CMS would focus on three areas in the CY 2015 OPPS proposed rule: developing new comprehensive APCs, packaging ancillary services, and collapsing evaluation and management (E/M) codes for emergency department (ED) visits. 

CMS proposed to collapse the five E/M codes for ED visits into one code in the CY 2014 proposed rule but did not finalize this proposal last year, choosing to retain the current five levels of codes for both Type A and Type B ED visits.  In the CY 2014 final rule, CMS cited concerns that collapsing ED visit codes to one code might underrepresent the resources required to treat the most complex patients, such as trauma patients.  CMS committed, however, to “reevaluating’” the most appropriate payment structure for Type A and Type B ED visits.

Contact:

Susan Xu, M.P.A, M.S.
Lead Research Analyst
Telephone: 202-860-6012
Email: sxu@aamc.org

Matthew Baker, M.S.
Data Management Specialist
Telephone: 202-903-0805
Email: mbaker@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org