CMS floats 2.6% hospital outpatient pay increase for 2025: 7 things to know

CMS has published its Outpatient Prospective Payment System proposed rule for 2025, which, among other things, would raise Medicare outpatient payment rates for about 3,500 hospitals and 6,100 ASCs next year. 

Seven things to know:

1. CMS has proposed a 2.6% outpatient pay increase for hospitals in 2025. This update is based on the projected hospital market basket percentage increase of 3%, reduced by a 0.4 percentage point productivity adjustment.

2. The agency seeks to align hospital payments for remote services and telehealth. Under the proposed rule, outpatient therapy, mental health services, diabetes self-management training and medical nutrition therapy services provided by hospitals to patients in their homes would be billed under the physician fee schedule. 

3. The agency is proposing the rural emergency hospital quality reporting program adopt several measures, including the hospital commitment to health equity, the screening for social drivers of health and the screen positive rate for social drivers of health measures. The REH reporting period for the risk-standardized hospital visits within seven days after hospital outpatient surgery measure would be extended from one year to two years, beginning in 2025. 

4. Additionally, CMS proposes that, after conversion to REH status, REHs would be required to report data under the REHQR program. Under the rule, REHs would begin submitting data to the program on the first day of the quarter after a hospital has successfully converted to a REH. 

5. The proposed rule would make several changes to the hospital outpatient quality reporting program — a pay-for-reporting program that reduces payments to hospitals that do not meet requirements. The proposed changes include the adoption of the hospital commitment to health equity measure and removing the MRI lumbar spine for low back pain measure in 2025. 

6. CMS aims to continue voluntary reporting of the core clinical data elements and linking variables for both the hybrid hospital-wide readmission and hybrid hospital-wide standardized mortality measures from July 1, 2023, through June 30, 2024, affecting the 2026 payment determination for the hospital inpatient quality reporting program — a pay-for-reporting quality program that reduces payments to hospitals that do not meet requirements.

7. The proposed rule would also update Medicare payment rates for partial hospitalization and intensive outpatient program services provided in hospital outpatient departments. The existing structures of these programs would be maintained. However, CMS would use 2023 claims data and the latest available cost information from reports beginning three fiscal years prior to the year subject to the rulemaking.

CMS is seeking comments on the proposed rule through Sept. 9 and will issue the final rule in early November. 

Click here to read the 984-page proposed rule.

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