Medicare Approves Slight Raises in HOPD, ASC Rates for 2013
Here are five of the major updates from CMS' final rule on outpatient services.
• HOPD Medicare payments in 2013. HOPD Medicare rates affect roughly 4,000 hospitals that are paid under the Hospital Outpatient Prospective Payment System. For CY 2013, HOPD Medicare payment rates will increase by 1.8 percent. CMS justified the increase based on the projected hospital market basket of 2.6 percent and a reduction of 0.8 percent in "statutory reductions," such as productivity levels.
CMS said total payments to hospitals paid under the OPPS will be approximately $48.1 billion in 2013 — an increase of $4.6 billion compared with 2012. CMS also noted that OPPS payments are now based on geometric mean costs instead of median costs, which it said "better reflects average costs of services."
• Rural hospital outpatient adjustments. CMS said it will continue a 7.1 percent adjustment for OPPS payments to certain rural hospitals, such as sole community hospitals and critical access hospitals. The adjustment will apply to all services paid under the OPPS, but it excludes payable drugs, biologicals and some devices.
• Cancer hospital payment adjustment. CMS decided to continue its cancer hospital payment adjustment in 2013. The policy provides additional payments to 11 cancer hospitals for outpatient services so the cancer hospital's payment-to-cost ratio is equal to the weighted PCR average of other OPPS hospitals. CMS said the PCR will be 0.91 to determine next year's cancer hospital payment adjustment.
• ASC Medicare payments in 2013. Roughly 5,000 ASCs participate in Medicare, and they will see payment rate increases of 0.6 percent. The figure was based on the projected inflation rate of 1.4 percent minus a law-mandated productivity adjustment of 0.8 percent. Total Medicare payments to ASCs will be approximately $4.07 billion next year.
• Hospital Outpatient Quality Reporting Program. CMS did not add any new measures to the existing 22 under the Hospital OQR Program for CY 2014, but CMS did clarify data collection policies for several of the measures.
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