CMS releases OPPS proposed rule for 2017: 12 things to know

CMS has released its 2017 Medicare Outpatient Prospective Payment System proposed rule, which implements site-neutral payment provisions of the Bipartisan Budget Act of 2015 and removes questions about pain management from Medicare's Value-Based Purchasing Program.

Here are 12 things to know about the 2017 proposed rule.

Site-neutral payment provisions
1. CMS proposed implementing the site-neutral payment provisions of Section 603 of the Bipartisan Budget of 2015, which states that off-campus provider-based departments (PBDs) that began billing under the OPPS on or after Nov. 2, 2015 would no longer be paid for most services under the OPPS. Instead, beginning Jan. 1, 2017, these facilities would be paid under other applicable Medicare Part B payment systems. CMS proposed that the physician fee schedule be the applicable payment system for the majority of services provided in new off-campus PBDs in 2017.

2. Under the proposed rule, services provided in a dedicated emergency department would continue to be paid under the OPPS.

3. CMS proposed certain restrictions on off-campus PBDs that began billing under the OPPS prior to Nov. 2, 2015. For instance, these departments must continue to offer the same services and bill from the same physical address as they did on Nov. 2, 2015 to be excepted from the site-neutral payment provisions. However, CMS is requesting comment on whether there should be exceptions to this proposal for extraordinary circumstances that are outside the hospital's control.

4. The American Hospital Association issued a statement Wednesday, expressing its disappoint with CMS' "short-sighted" proposal.   

"Hospitals and health systems and more than half of the House and the Senate requested that CMS provide reasonable flexibility when implementing Section 603 of the Balanced Budget Act of 2015 in order to ensure that patients have continued access to hospital care," Tom Nickels, executive vice president of government relations and public policy at the AHA, said. "Instead, the agency is actually proposing to provide no funding support for outpatient departments for the services they provide to patients. This does not reflect the reality of how hospitals strive to serve the needs of their communities. In addition, CMS' refusal to continue current reimbursement to hospitals that need to relocate or rebuild their outpatient facilities in order to provide needed updates and ensure patient access is unreasonable and troubling."

Payment update
5. CMS has proposed updating the OPPS rates by 1.55 percent in 2017. CMS arrived at its proposed rate increase through the following updates: a positive 2.8 percent market basket update, a negative 0.5 update for a productivity adjustment and a negative 0.75 percent update for cuts under the Affordable Care Act.

6. After considering all other policy changes included in the proposed rule, CMS estimates OPPS payments would increase by 1.6 percent and ASC payments would increase by 1.2 percent in 2017.

Hospital Value-Based Purchasing Program
7. Beginning with the fiscal 2018 program year, CMS has proposed removing the pain management dimension of the HCAHPS survey for purposes of the Hospital Value-Based Purchasing Program.

8. CMS decided to remove the pain management dimension after receiving feedback from industry stakeholders who believe linking patient satisfaction on pain management to VBP Program payment incentives puts pressure on hospital staff to prescribe more opioids. CMS said it is not aware of any scientific studies that support the belief that opioid prescribing practices are linked to the pain management dimension of the HCAHPS survey. However, CMS said it is proposing to remove the pain management questions in an "abundance of caution."

Electronic Health Record Incentive Program
9. To offer greater flexibility in the meaningful use of EHRs, CMS has proposed a 90-day EHR reporting period in 2016 for all eligible professionals and hospitals. The reporting period would be any continuous 90-day period between Jan. 1, 2016, and Dec. 31, 2016.

10. Regarding meaningful use, CMS said it is not feasible for physicians and hospitals that have not demonstrated meaningful use in a prior year to attest to the Stage 3 objectives and measures in 2017. Under the proposed rule, these new participants would be required to attest to Modified Stage 2 by Oct. 1, 2017.

Hospital Outpatient Quality Reporting Program
11. For 2017, CMS has proposed adding seven measures to the Hospital Quality Reporting Program for the 2020 payment determination and subsequent years.

Comment period
12. CMS will accept comments on the proposed rule until Sept. 6.

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