Dec. 2—Medicare plans to pay a single rate for hospital outpatient clinic visits in 2014, instead of the five different rates it currently pays.

The change, included in the final Hospital Outpatient Prospective Payment System (OPPS) rule scheduled for publication on Dec. 10, will replace the five levels of outpatient clinic visit codes with a single Healthcare Common Procedure Coding System (HCPCS) code describing all clinic visits.

“A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit,” said a release from the Centers for Medicare & Medicaid Services (CMS).

The change drew immediate objections from hospital advocates over concerns that Medicare will now pay hospitals that care for large numbers of complex patients far less than the cost of treating them. 

“We continue to have concerns that CMS may not have used accurate information in developing these policies and that hospitals will have neither the time nor the data to understand how these changes will affect their ability to provide patient services,” Rick Pollack, executive vice president for the American Hospital Association, said in a Nov. 27 written statement. “In adopting these proposals, CMS has put hospitals in the difficult position of having only 35 days to implement significant changes in Medicare’s policies, procedures, and payment formulas.”

Other changes in the rule that drew concerns included the plan to package payments for multiple supporting items and services into a single payment for a primary service, similar to the way Medicare pays for hospital inpatient care. CMS will combine supporting items, including drugs, biologicals, and radiopharmaceuticals, in a single payment for a primary service to the hospital when they are used in a diagnostic test or procedure, among other situations.

Rural Hospitals Impacted

Hospital advocates also raised concerns that the rule allows a suspended requirement for physician supervision of outpatient therapeutic services provided by critical access hospitals and small rural hospitals, to go into effect in 2014.

“Given the shortage of medical professionals, this policy may force small and rural hospitals and critical access hospitals to limit their hours of operation or cut services to comply with the provision, resulting in reduced access to outpatient care in communities across America,” Pollack said.

The hospital group plans to continue pushing for a legislative change to the requirement.

The final rule increased overall payments for hospital outpatient departments by an estimated 1.7 percent. 

Another policy change was the creation of an encounter-based or “comprehensive” payment for certain device-related procedures like cardiac stents and defibrillators. However, the final rule delayed implementation of this provision until 2015.

CMS dropped plans in an earlier proposed rule to replace the five levels of codes for each type of emergency department visit, which also had raised hospital objections. However, CMS plans to try other changes to the emergency department payments in the future, according to a CMS fact sheet.

The rule also will increase ambulatory surgical center payments by 1.2 percent in 2014, although ambulatory surgical centers that do not meet the CMS quality reporting program requirements will face a 2 percent cut.

The rule finalized four new measures for the hospital outpatient quality reporting program, which would affect payments in 2016. The final rule also removed two measures for the CY15 payment determination and subsequent years.

Changes to the hospital value-based purchasing program include the establishment of performance and baseline periods for the catheter-associated urinary tract infection, central line-associated bloodstream infection, and surgical site infection measures for the FY16.

Comments on the final rule are due by Jan. 27.

A separate rule also set for publication on Dec. 10 finalized the CY14 Medicare physician fee schedule.

Publication Date: Monday, December 02, 2013