Nov 16 2010
CMS has released its CY 2011 final rules for hospital outpatient and ambulatory surgery center payment (the “Final Rule”). As described by CMS, notable provisions of the Final Rule relate to:
- CMS’s application of a 2.35% update to the OPPS for CY 2011.
- CMS’s application of a 0.2% update to the ASC payment system for CY 2011.
- Waiver of the Part B deductible and coinsurance for certain preventive services paid under the hospital outpatient prospective payment system (including the initial preventive physical examination) and certain preventive services paid under the ambulatory surgery center payment system.
- CMS’s decision not to finalize a payment adjustment for cancer hospitals for 2011. The health care reform legislation (PPACA) requires CMS to make a budget neutral payment adjustment if outpatient costs incurred by certain cancer hospitals exceed the outpatient costs incurred by other OPPS hospitals.
- Additional quality measures for hospital outpatient departments to report. CMS is adding four quality measures (including a health information technology measure and three imaging efficiency measures) for the CY 2010 payment determination and eight new measures for the CY 2013 payment determination. Six of the new measures for the CY 2013 payment determination relate to the emergency department.
- CMS’s efforts to validate whether hospitals accurately report quality measures using chart-abstracted data. CMS will validate data from 800 randomly selected hospitals for the 2012 payment determination.
- Revisions to CMS’s supervision requirements for outpatient therapeutic services.
- The addition of six surgical procedures to the list of procedures that Medicare will cover in an ASC.
- A prohibition on the use of Stark’s “rural provider” and “whole hospital” exception by new physician-owned hospitals and limiting the ability of existing physician-owned hospitals to expand their capacity.
- Implementation of the direct and indirect graduate medical education provisions of PPACA. CMS must reallocate unused residency slots to certain hospitals with qualified residency programs. CMS also must reallocate residency slots from hospitals that will close down to other teaching hospitals. The new regulatory provisions also relate to how hospitals should count hours a resident spends in training and research activities and in patient care activities in a non-provider setting (e.g. in a physician’s office).