CMS Issues OPPS and ASC Payment Changes for 2012

CMS issued a proposed rule Friday updating hospital outpatient departments and ambulatory surgery centers.  CMS is projecting a market basket update in 2012 of 1.5 percent. This reflects an increase of 2.8 percent for hospital inpatient services paid under IPPS minus a productivity adjustment estimated to be 1.2 percent and minus a 0.1 percent adjustment.
The ASC payment system is updated annually by the consumer price index for all urban consumers, which CMS estimates to be 2.3 percent for 2012. Beginning in CY 2011, the Affordable Care Act requires any annual update under the ASC payment system to be reduced by a productivity adjustment. CMS projects that the productivity adjustment for 2012 will be 1.4 percent, and therefore, CMS is proposing to apply a 0.9 percent update for 2012.

Click here for a detailed summary of OPPS and ASC changes.

CMS Issues Changes to Physician Payments

CMS issued a proposed rule Friday that would update physician Medicare payment policies and rates for services on or after Jan. 1, 2012.  Included was a change to Professional Component (PC) payments for CT and MRI services.  Under this proposed policy, the procedures with the highest PC payment would be paid in full. The PC payment would be reduced by 50 percent for subsequent procedures furnished to the same patient, on the same day, in the same session. CMS estimates this would reduce payments for these services by about $200 million, which would be redistributed to other services.  Click here to review all the changes.
NOTE:  CMS noted that unless Congress acts, there will be a 29.5 percent payment reduction to physicians beginning January 1.  CMS Administrator Don Berwick said CMS will do everything possible to see that reduction doesn’t happen.

Changes Also Proposed for Physician Incentive Programs

The proposed rule also contained proposals for changes to the three incentive programs that are associated with MPFS payments — electronic prescribing, electronic health records, and the Physician Quality Reporting System – as well as changes to the Physician Compare tool on the Medicare.gov web site. Click here to see the summary.

CMS Proposes ESRD Payment and Policy Changes

The proposed 2012 End Stage Renal Disease market basket update is projected to be 3.0 percent, adjusted by a productivity adjustment factor, currently projected to be 1.2 percent, resulting in a projected update of 1.8 percent for 2012.  There were a number of significant payment policy changes also proposed, click here to read.

CMS Retracts Doc Signature for Lab Rule

CMS issued a proposed rule to retract its policy requiring the physician or NPP’s signature on an order for a service paid under the clinical lab fee schedule.  CMS finalized that policy in the CY 2011 PFS final rule effective November 1, 2011, but has received tremendous pushback from affected providers.  CMS is proposing to reinstate the prior policy that the signature of the physician or NPP is not required on a requisition for Medicare purposes for a clinical diagnostic laboratory test paid under the CLFS.  A copy of the proposed rule is attached here.

Hospice Payments Under Scrutiny

Concerns are growing about the use of Hospice because of its growing budget impact.  Read a very good New York Times article about it here.

Bipartisan Senate Proposal Makes Major Medicare Changes

Bipartisan legislation to reform Medicare was proposed last week by two of the Senate’s best known members.  Joe Lieberman (I-CT) and Tom Coburn (R-OK) said further Medicare changes had to be made to keep the program solvent.  Although the plan was largely panned by Senate and House leadership, it contains a number of long-discussed changes including increasing the eligibility age and means testing.  It also includes hits to home health and eliminating payments for hospital bad debts.  Click here to read the 5-page proposal.

Proposed Changes Would Simplify Paperwork, Save Billions:  CMS

CMS issued an interim final rule last week that requires compliance by health plans, health care clearinghouses, and certain health care providers by January 1, 2013.  It puts in place operating rules for two electronic health care transactions, making it easier for providers to determine:  whether a patient is eligible for coverage and the status of a health care claim submitted to a health insurer.  The changes could save $12 billion.  Click here for details.

IPAB Opponents Continue Drive Against Agency

More than 270 organizations signed a letter to Congress last week opposing the Independent Payment Advisory Board.  IPAB is the Obama Administration’s current answer to cutting government health care spending and it is also part of the Affordable Care Act.  A copy of the letter is attached here.

Studies/Reports Out Last Week:
  • State health exchanges offer the opportunity for lower consumer health care costs and greater choice, says U.S. PIRG.  It is a pretty good primer on exchanges.  Click here for the 37-page report.
  • Seniors on Medicare are paying more and more out-of-pocket for their health care and have relatively modest means, according to new reports from the Kaiser Family Foundation.  Click here.
  • The Robert Wood Johnson Foundation has put together a new national data base that aggregates websites that compare hospitals and doctors – state-by-state.  Click here.

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