Major hospital organizations are in the process of review this 800+ proposed bill. Some of their initial reactions to this bill are below. This RevCycleIntelligence article does a nice job of summarizing the pros and cons from a hospital perspective.
The newly proposed Medicare Outpatient Prospective Payment System (OPPS) rule for calendar year (CY) 2022 is causing a stir with new hospital price transparency enforcement rules and other policies.
The rule released earlier this week contained important updates to new hospital price transparency requirements, which mandate hospitals to publish payer-specific negotiated rates and other pricing information on their public websites. The rule also included key updates to OPPS and ambulatory surgical center Medicare rates, 340B payments, and the Radiation Oncology Model.
While hospital groups are hoping CMS finalizes some Medicare outpatient reimbursement policies in the proposed rule, they are criticizing the agency’s decision to include policies like higher hospital price transparency penalties for noncompliance and lower 340B payment rates.
PRO: IPO LIST CHANGES
The American Hospital Association (AHA) is giving a big thumbs up to CMS for proposing to halt the elimination of the Inpatient-Only (IPO) list, which dictates the services that are only payable by Medicare if performed in the inpatient setting.
CMS was phasing out the list under the CY 2021 OPPS final rule by removing nearly 300 services from the 1,700-service list. The agency said the IPO list may have restricted patient choice when it came to surgery.
However, the agency plans to roll back the IPO list’s elimination after receiving many comments from stakeholders. The CY 2022 OPPS proposed rule would also add back the services taken off the list in 2021, if finalized as is.
Similarly, CMS is proposing to reinstate safety criteria for services that can be performed in ASCs. The rule would also remove 267 procedures from the ASC Covered Procedures List that were added in CY 2021.
CON: HIGHER PENALTIES FOR PRICE TRANSPARENCY NONCOMPLIANCE
A major sticking point for hospital groups is CMS’ proposal to increase penalties imposed on hospitals that are not compliant with new price transparency requirements. The CY 2022 OPPS rule would implement a minimum civil monetary penalty of $300 per day for smaller hospitals with a bed count of 30 or fewer and $10 per bed per day for hospitals with a bed count greater than 30, up to a daily dollar amount of $5,500. This means the maximum penalty per hospital would increase from about $110,000 per year to over $2 million per year.
Hospitals have cited ongoing pressures from COVID-19 as a reason why CMS should delay price transparency requirements. Compliance with the requirements has been low since the requirements went into effect at the start of this year, with recent data showing that an overwhelming majority of randomly selected hospitals were not compliant with at least one major requirement.
CON: 340B PAYMENT RATE METHODOLOGY
Much to the disappointment of hospitals, CMS is proposing to maintain a payment rate methodology that has resulted in significant cuts to hospital outpatient reimbursement for drugs acquired through the 340B Drug Pricing Program.The CY 2022 OPPS proposed rule would keep rates at average sales price (ASP) minus 22.5 percent for qualifying outpatient drugs—the rate at the center of a Supreme Court case brought on by hospital groups.
Payment cuts of nearly 30 [percent] that have been in place since 2018 have made it more difficult for these hospitals to provide critical health services and support to these patients in need. The reductions have forced some of these hospitals to cut services or cancel care expansion plans to maintain other core services for their patients and communities.
PRO: HEALTH EQUITY, ACCESS TO CARE REQUESTS
While not policy yet, CMS is calling on stakeholders in the CY 2022 OPPS proposed rule to provide more information on ways the agency can advance health equity and access to care for rural patients. Specifically, the proposed rule would set forth a request for information on ways to report health disparities based on social risk factors and a separate request for information on policy proposals for CY 2023 that would establish a new type of rural emergency hospital.
The COVID-19 pandemic has shone a light on the shortcomings of rural access to care and health disparities. Hospitals are making both top priorities in order to ensure access to care and health equity in a post-pandemic environment. The new proposed rule indicates that CMS is also making these top priorities and health policy is soon to follow.
We are supportive of reinstating the IPO List and the effort to provide equitable medical care in rural communities. The 340B payment reductions only hurt the “safety net” hospital community which provides care to poorer patient locations.
It’s a mystery to us why CMS is requesting “standard fees” from hospitals for price transparency. The effort should be to provide individual patients with access to their insurance plans which outline their payment responsibilies.