CMS' 2019 proposed rule for the Outpatient Prospective Payment System and ASC Payment System covers several topics relevant to anesthesia providers, according to Anesthesia Business Consultants President and CEO Tony Mira.
CMS is taking comments on the proposed rule until Sept. 14. The final rule is expected to be published in early November.
Here are the anesthesia-related topics the rule addresses:
1. Non-opioid pain management. CMS currently gives hospitals a single bundled payment to hospitals for surgical supplies, including medication for postoperative pain. CMS found use of some non-opioid drugs decreased in ASCs under current packaging policies for pain medications, but not in hospital outpatient department settings. As a result, CMS proposed unpackaging and paying separately for these drugs in ASCs, with the payment being the average sales price plus six percent. CMS is seeking comments and research into whether separate payment in outpatient hospital settings could encourage non-opioid use.
2. Anesthesia for knee procedures. The proposed rule includes a recommendation to remove CPT Code 01402 from the inpatient-only list. CPT Code 01402 relates to anesthesia for open or surgical arthroscopic procedures on the knee joint. The rule would reimburse anesthesia practitioners for these procedures in outpatient settings.
3. Hospital Consumer Assessment of Healthcare Providers and System pain questions. CMS proposed removing three Communication About Pain questions from the HCAHPS survey in 2022:
- During this hospital stay, did you have any pain?
- During this hospital stay, how often did hospital staff talk with you about how much pain you had?
- During this hospital stay, how often did hospital staff talk with you about how to treat your pain?
The agency proposed the change because of concern the questions could pressure clinicians to prescribe more opioids for higher scores.
4. Site neutrality expansion, 340B. CMS proposed expanding the site-neutral payment policy implemented by the Bipartisan Budget Act of 2015 to reduce payments for sites originally exempt from the policy. CMS proposed extending reimbursement cuts for outpatient drugs under the 340B program to off-campus hospital departments that already had payment reductions.