CMS on July 10 shared a proposed Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System rule that would update payments by 2.6%.
The proposed rule will have a 60-day comment period ending Sept. 9, and the final rule will be issued in November.
Seven things to know:
1. CMS is proposing an updated outpatient prospective payment system rates for hospitals meeting applicable quality reporting requirements by 2.6%. That decision is based on a projected market basket percentage increase of 3% and reduced by a 0.4% point productivity adjustment.
2. The proposed rule would also keep the existing rate structure with two intensive outpatient program ambulatory payment classifications — one for days with three services per day and one for days with at least four services per day. CMS is proposing using 2023 claims data and current cost information for rate setting in 2025.
3. The proposed rule would also update Medicare payments for the partial hospitalization program services in HOPDs. Similar to the IOP structure, the existing rate structure based on provider type would be maintained and pull rates from 2023 claims data and current cost details.
4. For the ASC quality reporting program, CMS is proposing a Facility Commitment to Health Equity measure that would include voluntary reporting on social determinants of health. CMS is also looking to modify the immediate measure removal policy to an immediate measure suspension policy.
5. CMS is seeking comments on a request for information regarding development of a specialty focused reporting and minimum case number for required reporting framework. The agency is considering a revision of the data reporting requirements that would ask ASCs to report data only on "quality measures that are generally applicable to all ASCQR Program individuals and relate to the conditions they treat or procedures they perform or can be abstracted from claims."
6. CMS is proposing a change to the hospital outpatient quality reporting program that would remove the MRI lumbar spine measure for patients with low back pain. The agency reasoned that " recent studies have found that performance or improvement on the measure did not result in better patient outcomes."
7. An analysis from the Ambulatory Surgery Center Association balked at CMS' omission of proposed code additions that were submitted by the organization.
"It is disheartening that CMS established a new, supposedly more transparent process for submitting procedure codes that could be added to the ASC Covered Procedures List, yet proceeds in this proposed rule to ignore the 18 cardiac and spine codes we submitted," ASCA CEO Bill Prentice said in a statement. "Medicare beneficiaries would have more access to the care they need if the agency simply relied on the clinical expertise of surgeons who safely perform these procedures and who are best positioned to know where they can be performed."