CMS releases OPPS proposed rule for 2018: 10 things to know

CMS has released its 2018 Medicare Outpatient Prospective Payment System proposed rule, which would cut payments to hospitals under the 340B Drug Pricing Program and authorize Medicare to reimburse for knee replacement surgeries performed in outpatient facilities.

Here are ten things to know about the 2018 proposed rule.

Payment update
1. CMS proposed updating the OPPS rates by 1.75 percent in 2018. The agency arrived at its proposed rate increase through the following updates: a positive 2.9 percent market basket update, a negative 0.4 percentage point update for a productivity adjustment and a negative 0.75 percentage point adjustment for cuts under the ACA.

2. After considering all other policy changes included in the proposed rule, except for the provisions related to 340B drug payments, CMS estimates hospital OPPS payments would increase by 2 percent next year.

Proposed 340B program changes
3. CMS proposed paying hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B program. That's compared to the current payment rate of average sales price plus 6 percent. Under the proposed rule, the current payment would continue for vaccines.

4. Regarding the proposed 340B program changes, CMS said it "seeks comment on implementing this proposal in a manner that will bring down out-of-pocket drug costs for Medicare patients and allows providers to best meet their patients' needs."

5. The American Hospital Association issued a statement Thursday, expressing its concerns with the proposed modifications to the 340B program.

"Cutting Medicare payments for hospital services in the 340B program is not based on sound policy. Additionally, this proposed rule punishes hospitals for a policy outside of CMS' jurisdiction. It is unclear why the administration would choose to punitively target 340B safety-net hospitals serving vulnerable patients, including those in rural areas, rather than addressing the real issue: the skyrocketing cost of pharmaceuticals," Tom Nickels, executive vice president of the AHA, said. 

Proposed update to inpatient-only list
6. The Medicare inpatient-only list includes procedures that are only paid for under the Hospital Inpatient Prospective Payment System. Each year, CMS reviews the list to determine whether any procedures should be taken off of the list. For 2018, CMS proposed removing total knee arthroplasty from the IPO list. The proposed rule also seeks comment on whether partial and total hip arthroplasty should be removed from the list. 

Hospital Outpatient Quality Reporting Program changes
7. For 2018, CMS is proposing removing two measures from the Hospital Quality Reporting Program for the 2020 payment determination and subsequent years. The measures CMS is proposing to remove are:

  • OP-21: Median time to pain management for long bone fracture
  • OP-26: Hospital outpatient volume data on selected outpatient surgical procedures

8. For 2019, CMS is proposing removing four measures from the Hospital Quality Reporting Program for the 2021 payment determination and subsequent years. The measures CMS is proposing to remove are:

  • OP-1: Median time to fibrinolysis
  • OP-4: Aspirin at arrival
  • OP-20: Door to diagnostic evaluation by a qualified medical professional
  • OP-25: Safe surgery checklist use

Possible revisions to laboratory date of service policy
9. CMS said it is considering potential modifications to the laboratory date of service policy. The changes would allow labs to bill Medicare directly for molecular pathology tests and advanced diagnostic laboratory tests excluded from the OPPS packaging policy and ordered less than two weeks following the date of a patient's discharge from the hospital. Under currently policy, if a test is ordered less than two weeks after a patient's discharge date, the hospital must bill Medicare for the test and then pay the lab that performed the test.

Comment period
10. CMS will accept comments on the proposed rule until Sept. 11.

Editor's note: This article was updated July 18.

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