CMS' final outpatient payment rule for 2019: 7 things to know

CMS released its 2019 Medicare Outpatient Prospective Payment System final rule Nov. 2, which includes site-neutral payment policies and makes changes to the 340B Drug Pricing Program.

Here are seven things to know about the final rule:

Payment update

1. CMS is increasing the OPPS rates by 1.35 percent in 2019. The agency arrived at the rate increase through the following updates: a positive 2.9 percent market basket update, a negative 0.8 percentage point update for a productivity adjustment and a negative 0.75 percentage point adjustment for cuts under the ACA.

Site-neutral payments

2. Under the final rule, CMS is making payments for clinic visits site-neutral by reducing the payment rate for hospital outpatient clinic visits provided at off-campus provider-based departments by 60 percent. Based on a two-year phase-in of this policy, half of the total reduction will apply in 2019.

3. The clinic visit is the most common service billed under the OPPS, and CMS estimates this change will save the Medicare program and beneficiaries a combined $380 million in 2019.

340B program

4. CMS scaled back the 340B program in 2018, and the agency is implementing additional cuts for next year.

5. On Jan. 1, 2018, CMS began paying hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B program. That's compared to the previous payment rate of average sales price plus 6 percent. Under the final OPPS rule for 2019, CMS is extending the average sales price minus 22.5 percent payment rate to 340B drugs provided at nonexcepted off-campus provider-based departments.

Hospital Outpatient Quality Reporting Program

6. CMS is removing one measure from the Hospital Outpatient Quality Reporting Program beginning with the 2020 payment determination and removing seven other measure beginning with the 2021 payment determination.

7. "The removal of these measures is consistent with the CMS' commitment to using a smaller set of more meaningful measures and focusing on patient-centered outcomes measures, while taking into account opportunities to reduce paperwork and reporting burden on providers," CMS said in a fact sheet about the final rule.

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