CMS proposes changes to 2017 payment models

New rules from CMS on payment systems were released July 6, according to a statement from the government agency.

The new regulations would cover payments made through the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center Payment System (ASC). The American College of Radiology (ACR) pointed out that changes to those systems also means a change to Medicare and Medicaid payments to many radiology providers.

Overall, CMS says this change would switch the focus of payment from where the treatment is happening to the actual care of the patient. That change, first prescribed in the 2015 Bipartisan Budget Act, would de-incentivize hospital systems from making care setting choices based on payment, and instead incentivize them to make those decisions based on care quality. CMS’ statement also highlights the hope that this would save the Medicare and Medicaid programs and their respective beneficiaries up to $500 million while shifting more of the financial risk of the treatment back onto the healthcare providers.

More specifically, in radiology, ACR says the change in the system would shuffle some imaging payment categories under Comprehensive Ambulatory Payment Classifications (C-APC). The 17 current imaging APCs would be consolidated into eight classifications.

ACR explained this change, saying “The proposed restructure is intended to keep radiology together within the diagnostic imaging family but to re-categorize them to be more clinically similar with respect to resource use. CMS removed interventional radiology imaging studies and nuclear medicine from the Diagnostic APC structure.”

Also affecting radiology, CMS said it would review rules regarding film-taken x-ray payment reduction. As it stands, claims from imaging taken on film would be subject to a 20 percent payment reduction from CMS starting in 2017, in accordance with the Consolidate Appropriations Act, according to the ACR.

The proposed 2017 rule changes also included updates on payment conversion rates. The OPPS rates will increase by about 1.55 percent, marking a 1.6 percent increase in payments to hospitals for the next year, and ASC payments are expected to increase by 1.2 percent, according to CMS.

The new rules also propose adding new C-APCs to make related treatments be classified together during payment processes.

The ACR has not yet commented on the proposed rules, but is expected to do so shortly.

The new rules would go into effect starting Jan. 1, 2017. The proposed regulations are now open for a period of public comment through September 6.