CMS Ultimately Finalizes Hospital Outpatient Prospective Payment System Modifications

The Centers for Medicare & Medicaid Services (CMS) has finalized the updated payment rates and policy modifications today in the Ambulatory Surgical Center (ASC) Payment System and Hospital Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2017. These modifications will make better the quality of care Medicare sufferers got by better supporting their physicians and other health care providers and depict a broader Administration-wide method to develop a health care system that will give rise to better care, smarter spending, and healthier people.

New quality measures to the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program is also being added by CMS that are concentrated on improving patient results and experience of care. CMS got nearly 3,000 public comments on the proposed rule, which were precisely considered for the final rule with comment time period.

The updates and changes in the final rule would increase OPPS payments by 1.7% and ASC rates by 1.9% in the year of 2017, in accordance to CMS’s estimations.

Dealing the Concerns of Physicians Regarding Pain Management
The final rule of today would deal physicians’ and other health care providers’ uncertainties that patient survey asks about pain management in the Hospital Value-Based Purchasing program unduly influence prescribing practices. Though, there is no empirical proof of such an impact, we’re finalizing the eradication of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey for the intentions of the Hospital Value-Based Purchasing Program to remove any economical pressure clinicians might feel to over-prescribe medications. According to CMS, pain control is a suitable part of routine patient care that hospitals should handle, and is a core concern for sufferers, their families, and their caregivers. 

Focusing Payments on Patients Instead of Setting
To implement section 603 of the Bipartisan Budget Act of 2015, CMS is finalizing policies which need that few items and services furnished by some off-campus hospital outpatient departments will no longer be paid under the OPPS starting on the day of January 1, 2017. In current case, Medicare pays for the similar services at a higher rate if those services are offered in a hospital outpatient department instead of a physician’s office. This difference in payment has given an incentive for hospitals to acquire physician offices in case to get the higher rates.
 
Making better the Patient Care through Technology
Physicians and other providers are being supported by CMS through today’s rule by increasing flexibility for eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) that engage in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS issued the final rule on the new Quality Payment Program for clinicians (CMS-5517-FC) on 14th October, 2016, which involves provisions developing the Merit-Based Incentive Payment System (MIPS), a latest program for few Medicare-enrolled practitioners with a primary concentration on: quality; improvement tasks; cost; and utilization of certified EHR technology to support interoperability and advanced quality aims or objectives.

For further information, please visit: http://www.hhs.gov/about/news/2016/10/14/hhs-finalizes-streamlined-medicare-payment-system-rewards-clinicians-quality-patient-care.html.

CMS is making modifications today under the Medicare EHR Incentive Program for eligible hospitals and critical access hospitals (CAHs) attesting to CMS, involving hospitals that are eligible to engage in both the Medicare and Medicaid EHR Incentive Programs (dual-eligible hospitals), by removing the Clinical Decision Support (CDS) and Computerized Order Entry (CPOE) aims and steps starting in the year of 2017. CMS is decreasing a subset of thresholds for the left over aims and steps for Modified Stage 2 and Stage 3. Extra modifications involve permitting all returning participants in the EHR Incentive Programs to report on ninety-day EHR reporting period in the years of 2016 and 2017. An application procedure for a one-time significant hardship exception to the Medicare EHR Incentive Program is being finalized by CMS for certain EPs in the year of 2017 who are also transitioning to MIPS.

For more information about OPPS /ASC Final Rule and IFC please visit Federal Register at: https://www.federalregister.gov/public-inspection.

A fact sheet on this final rule and IFC is present at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-11-01-3.html.