CMS pushes for site-neutral payments with 2019 HOPPS proposed rule
CMS released the 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule and 2019 Ambulatory Surgical Center (ASC) Payment System proposed rule this week, pushing for site-neutral payments and updating OPPS payment rates by 1.25 percent.
The proposals include site neutral payments for clinic visits, the most common service billed under the HOPPS, which CMS says would save patients approximately $150 million in co-payments. This means Medicare would pay the same amount for clinic visits that it would pay for a visit to the physician’s office.
CMS is also pushing to increase payment rates under the ASC payment system by 2 percent.
According to CMS, its latest proposals “would help lay the foundation for a patient-driven healthcare system.”
“Our healthcare system should always put patients first, and CMS today is taking important steps to empower patients and provide more affordable choices and options,” CMS Administrator Seema Verma said in a prepared statement. “In line with President Trump and Secretary Azar’s priority to lower drug prices, today’s proposed rule is also an important step towards expanding competition for drug payment in Medicare, in order to get the best deal for patients.”
CMS is accepting public comments on its proposals by regular mail and electronically until Sept. 24. The agency is also issued three Requests for Information: one on interoperability, one on whether or not beneficiary access to provider and supplier charge information should be improved and one on “how to best develop a model leveraging authority provided to the agency under the Competitive Acquisition Program to strengthen negotiations for prescription drugs.”
The American College of Radiology noted in a statement that its staff “is preparing a detailed analysis of the proposed rule and will provide additional information in the coming week.” The Society of Nuclear Medicine and Molecular Imaging indicated it will respond to the rule in September.
The rules can be read here. A Fact Sheet from CMS is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.