Healthcare responds to CMS' proposed outpatient payment rule

CMS released its proposed 2019 rule updating the Medicare hospital outpatient prospective payment system and the Medicare ambulatory surgical center payment system.

Here are comments on the proposal from five industry organizations:

1. America's Essential Hospitals criticized the proposed rule, saying it would "impose draconian new cuts that jeopardize healthcare access for millions of vulnerable Americans," as well as "undermine the foundation of support for our nation's healthcare safety net." The organization specifically criticized extending reimbursement cuts for 340B Drug Pricing Program purchases to more hospital outpatient clinics.

Extending reimbursement cuts "doubles down on a policy that drains vitally needed support from hospitals that operate with thin or negative margins," Bruce Siegel, MD, president and CEO of AEH, said in a prepared statement. "Adding to these hospitals' financial woes — and likely to worsen care disparities in already underserved communities — are $610 million in arbitrary payment cuts for clinic visits. CMS proposes more cuts for new services, erecting yet another barrier to access."

2. The Association of American Medical Colleges also criticized extending cuts to safety-net hospitals that participate in the 340B Drug Pricing Program. It said the proposed rule contradicts a bill introduced in November that would rescind significant Medicare Part B payment cuts for certain hospitals that participate in the 340B Drug Pricing Program. The cuts are part of CMS' 2018 Medicare OPPS final rule.

"CMS' proposal to cut Medicare payments to existing outpatient departments for clinic services [also] runs counter to congressional intent and would seriously damage the ability of the nation's teaching hospitals to serve the most complex and vulnerable patients," AAMC President and CEO Darrell G. Kirch, MD, said in a prepared statement. "CMS should rescind the 340B policy and not finalize the cuts to off-campus outpatient department clinic visits."

3. The American Hospital Association echoed other industry comments, saying the federal government "misconstrued congressional intent" with the 2019 proposed rule.

"In 2015, Congress clearly intended to provide current off-campus hospital clinics with the existing outpatient payment rate in recognition of the critical role they play in their communities. But CMS' proposal runs counter to this and will instead impede access to care for the most vulnerable patients," Tom Nickels, executive vice president of the AHA, said in a prepared statement.

4. 340B Health, an association representing more than 1,300 hospitals and health systems participating in the 340B Drug Pricing Program, said CMS' proposal will "make a bad rule worse."

"In 2018, CMS slashed $1.6 billion from Medicare outpatient drug payments to many 340B hospitals, a reduction of nearly 30 percent. CMS now plans to make a bad rule worse by extending the cuts to drugs provided in certain off-campus hospital clinics, including facilities providing infusion therapy for cancer patients and other high-cost drug therapies to treat chronic and life-threatening conditions," the group said in a prepared statement.  

5. Aledade, a value-based care network, had a more positive reaction. Farzad Mostashari, MD, the network's founder and CEO, called the proposed rule "a significant and welcome proposal from the [Trump] administration to end incentives in the Medicare reimbursement system which increased costs for patients and promoted consolidation of healthcare providers."

"This will level the playing field between independent practices and huge healthcare systems. While hospitals, undoubtedly, will oppose this new rule, they should welcome it as it could help them become more competitive in value-based payment contracts — which is the future of health care," he said in a prepared statement.

 

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