House lawmakers to CMS: Site-neutral payment proposals may threaten shift to value

Members of the House of Representatives recently expressed concerns about CMS' site-neutral payment proposals, saying they may affect efforts to shift from fee-for-service to value-based care.

CMS is calling for site-neutral payments as part of its 2019 Medicare Outpatient Prospective Payment System proposed rule. Under the proposed rule, CMS would make hospital outpatient clinic visits site-neutral when performed off campus by reducing the payment rate for those visits to 40 percent of the OPPS rate. 

In a letter to CMS Administrator Seema Verma, House lawmakers said they are concerned the proposed changes to hospital outpatient services payment rates may damage the shift to value-based care.

"The proposed rule would implement a significant reduction in the payment of evaluation and management services delivered at off-campus hospital outpatient departments," they wrote.

The lawmakers said they want to ensure the proposed payment cuts in the rule are in line with CMS' aim to control unnecessary increases in outpatient department use. They said they are also concerned about what the proposal could mean for off-campus hospital outpatient departments grandfathered in under the 21st Century Cures Act, which revised the Bipartisan Budget Act of 2015. The 40 percent OPPS rate would apply to grandfathered off-campus hospital outpatient departments that begin to provide a new service to patients that wasn't offered before Nov. 1, 2015. The lawmakers said that could unfairly penalize grandfathered departments. 

"We share the agency's objectives of increasing efficiency, limiting costs incurred by beneficiaries and paying for value within the Medicare program," the lawmakers wrote. "However, we believe that these changes should not diminish progress made in the shift to value over volume. As providers enter into different, value-based payment arrangements it is important that rate changes do not undercut these arrangements."


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