The American Hospital Association sent a letter to CMS outlining concerns about the proposed hospital outpatient prospective payment system for 2017 that would include site-neutral payments, according to a Lexology report.
Here are five key notes on the AHA’s concerns:
1. The proposed rule implements the Bipartisan Budget Act of 2015’s site-neutral payment provision. The Act eliminates facility fees under OPPS for “off-campus hospital outpatient departments that relocated, changed service lines or began billing under OPPS” since Nov. 2, 2015. Under the 2017 proposed rule, the Medicare physician fee schedule would render payment to the physician performing the service.
2. Medicare defines an HOPD as having a fully integrated financial system with the hospital; this definition remains, however the proposed rule eliminates reimbursement the hospital previously received.
3. Medicare would still pay physician services at off-campus HOPDs. The AHA raised concerns about Stark Law and federal Anti-Kickback Statute violations. “To the extent that a hospital continues to pay overhead costs for a non-excepted HOPD, it could be perceived as offering free services and supplies to community physicians who provide services at the HOPD,” according to the report.
4. If included in the 2017 proposed rule, the change would go into effect Jan. 1, 2017, leaving hospitals little time to prepare.
5. The AHA reported concerns could be mitigated if hospitals employ physicians at the HOPD or the physicians were independent contractors of the hospital. However, there could be issues if the physicians collect from Medicare and don’t reimburse the hospital for HOPD expenses.