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

Washington Highlights

AAMC Comments on CY2017 OPPS Proposed Rule

September 9, 2016—The AAMC Sept. 6 submitted a comment letter on the Centers for Medicare and Medicaid Services’ (CMS’s) Outpatient Prospective Payment System (OPPS) proposed rule, which would update payment policies and rates for services furnished to Medicare beneficiaries in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs) beginning Jan. 1, 2017.

The AAMC’s comments focus on critical issues regarding: implementation of Section 603 of the Bipartisan Budget Act of 2015; lab packaging; and changes to the hospital Outpatient Quality Reporting (OQR) program.  The letter also addresses changes to the Electronic Health Record Incentive program and organ transplant and donation programs.

Implementation of Section 603

The AAMC strongly opposes CMS’s proposal to implement a narrow reading of Section 603 of the Bipartisan Budget Act of 2015, which, if finalized, would impact the ability of teaching HOPDs to care for vulnerable patient populations.

The AAMC urges CMS to delay implementation of Section 603 and continue to reimburse off-campus provider-based departments (PBDs) under the OPPS while the agency gathers stakeholder feedback, understands the impact of payment changes on patient access to needed services, and develops a different payment system for PBDs. The association believes CMS’s proposal to only pay physicians and other practitioners using the physician fee schedule in 2017 is untenable and will result in hospitals receiving no payment for items and services provided in PBDs during that year.

CMS is proposing to change the way it reimburses off-campus HOPDs that fall under Section 603.  The AAMC’s letter addresses CMS’s overly broad proposal to penalize HOPDs that relocate or expand their remote outpatient departments or add new services. CMS proposes that if an off-campus PBD moves or relocates from the physical location listed on the hospital’s enrollment form as of Nov. 2, 2015, neither the PBD nor items furnished there would be reimbursed under OPPS. HOPDs should not lose their ability to bill under the OPPS if they choose to move, relocate, or expand services in response to changes in clinical care and the needs of their patients.

Additionally, the AAMC requests that CMS confirm that these proposals will not have a negative impact on the ability of HOPDs to participate in the 340B Drug Pricing Program, as teaching hospitals depend on the program to expand access to care to underserved populations.

Hospital Quality Program

The AAMC urges CMS to ensure that new quality measures are fully vetted by the National Quality Forum (NQF) and reviewed under the NQF’s sociodemographic status trial period. The AAMC supports CMS’s proposal to decouple performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey’s pain management questions from value-based purchasing (VBP) payments. The association requests that these measures be temporarily removed from the survey and from Hospital Compare until new pain measures are developed.

Lab Packaging

The AAMC supports CMS’s proposal to discontinue the use of the L1 modifier, as hospitals have found it difficult to differentiate tests that have been ordered by different physicians and for different diagnoses. However, the association opposes packaging unrelated lab tests billed on the same claim and believes this proposal will likely result in inadequate reimbursement to providers. The AAMC also opposes CMS’s proposal to expand “Q1” and “Q2” packaging from the same date of service to the same claim.

The final rule will be released later this year.

Contact:

Mary Mullaney
Director, Hospital Payment Policies
Telephone: 202-909-2084
Email: mmullaney@aamc.org

Ayeisha Cox, J.D.
Hospital Policy & Regulatory Specialist
Telephone: 202-282-0482
Email: aycox@aamc.org

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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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For More Information

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