July 10—A proposed rule would increase outpatient Medicare payments by 1.8 percent and Medicare payments to ambulatory surgical centers (ASCs) by 0.9 percent in 2014.

The Centers for Medicare & Medicaid Services (CMS) issued the Outpatient Prospective Payment System (OPPS) proposed rule on Monday. Under the proposed rule, the hospital market basket increase is anticipated to be 2.5 percent, minus a productivity adjustment of 0.4 percent and a 0.3 percent reduction to the CY14 OPPS market basket, for a total proposed market basket increase of 1.8 percent.

The Medicare statute specifies a multifactor productivity adjustment to the ASC annual update. For CY14, the update is projected to be 1.4 percent, with a multifactor productivity adjustment of 0.5 percent, for a total proposed payment increase of 0.9 percent for CY14.  

Total CY14 OPPS payments are projected to increase by $4.37 billion, or 9.5 percent, due to changes in enrollment, utilization, and case mix, while CY14 Medicare payments to ASCs are projected to increase by approximately $133 million, or 3.51 percent, compared with CY13 figures. 

CMS also is proposing an increase in the downward adjustment of the value-based payment modifier from 1 percent in 2015 to 2 percent in 2016, according to the proposed rule. 

The value-based payment modifier is required by the Affordable Care Act and will affect payment rates to certain physician groups based on the quality and cost of care they furnish to beneficiaries enrolled in the traditional Medicare Fee-for-Service program.

In addition to adjusting the modifier, CMS is proposing to lower the group size subject to the modifier from physician groups with 100 or more eligible professionals (required for 2015) to physician groups with 10 or more eligible professionals (effective 2016). CMS estimates that this proposal will affect approximately 17,000 groups and nearly 60 percent of physicians in 2016.  

CMS also indicates that physicians could see a 24.4 percent payment cut come January 1, 2014. In prior years, Congress has taken action to avert a large reduction in physician fee schedule rates before they went into effect. It is unclear at this time whether that will occur again. The final physician fee schedule figure will be announced as part of the November final rule. 

Comments on the proposed rule will be accepted until Sept. 6.

Publication Date: Wednesday, July 10, 2013