CMS Proposes Outpatient Rate Increases for 2015

With all the news about declining payments to hospitals, gratifying news surfaced last week: the Centers for Medicare and Medicaid Services (CMS) wants to raise Medicare outpatient payments to hospitals by 2.1 percent in 2015. Ambulatory surgery center payments would increase by 1.2 percent. The proposed increases are higher than those finalized by CMS for 2014.


If the proposed rule goes into effect, Medicare would pay hospitals $56.5 billion under the policy in 2015, an increase of $5.2 billion over 2014. Ambulatory surgery centers would receive $4.1 billion, an increase of $243 million compared to 2014, according to the proposed rule.


Hospitals would still be required to meet outpatient quality reporting requirements. Those that fail to meet those requirements would continue to have their Medicare payments reduced by 2 percent. However, CMS also proposed removing three quality measures from the reporting program: emergency department heart attack patients who receive aspirin within 24 hours and two metrics involving administering antibiotic prophylaxis to surgery patients. (“CMS plans to raise outpatient rates, bundle payments for ancillary services,” Modern Healthcare A.M., July 7, 2014)


CMS also wants to pay a bundled rate for ancillary services that have an average cost of $100 or less, according to the proposed rule. Preventive services, psychiatric services and drug administration-related services would be excluded from this bundled rate.


CMS has been pushing for “comprehensive ambulatory payment classifications,” which would result in a single Medicare payment to providers instead of several separate charges. For 2015, CMS proposed 28 comprehensive ambulatory payment classifications. (“CMS plans to raise outpatient rates, bundle payments for ancillary services,” Modern Healthcare A.M., July 7, 2014)


The rule would affect more than 4,000 hospitals and 5,300 ambulatory surgery centers. Comments on the proposed rule will be accepted through September 2 and a final rule is expected around November 1.



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