The OPPS proposal failed to address several high-profile issues that industry leaders await reform.
Federal officials yesterday released a pair of proposed rules featuring possible adjustments to the Medicare Physician Fee Schedule (PFS) and Outpatient Scheduled Payment System (OPPS) for calendar year 2024.
The Centers for Medicare and Medicaid Services (CMS) announcement emphasized updating rates, promoting health equity, and expanding access to critical health services such as behavioral health and specific oral health services, while Biden・He also played a role in advancing the policies of the Harris administration. The “cancer moonshot” mission to accelerate the fight against cancer will be realized only by the rules of his PFS proposal.
“CMS’ mission is to expand access to health care and ensure that health insurance is meaningful to the people we serve,” said CMS Administrator Chiquita Brooks Rashua in a statement. Stated. “CMS’ proposals in the proposed Physician Payments Rule will help people in Medicare navigate cancer care and access a wider range of behavioral health care providers, helping them to access a broader range of primary care providers.” and for the first time allow Medicare to pay for services performed by local health workers.”
“CMS remains committed to advancing health equity and building stronger Medicare programs,” added Meena Seshamani, Deputy Administrator of CMS and Director of the Center for Medicare. “Once this rule proposal is finalized, the people we serve will have their own unique stories and individual It ensures that you experience a coordinated care experience that focuses on holistic care, taking into account the needs of the individual, and is comprehensive, all of which provide the care that Medicare subscribers should receive. very important for.”
Overall, officials said the proposed payments under the PFS would be cut by 1.25% compared to 2023, according to “factors specified by law.” CMS proposed increased payments for many outpatient services, such as primary care, requiring offsetting and budget neutrality adjustments for all other services paid under PFS. The proposed 2024 PFS conversion factor is $32.75, a decrease of $1.14 (3.34%) from 2023.
The proposed rule would provide access to adequate services, including what the agency describes as “addressing unmet health-related societal needs that may hinder the diagnosis and treatment of medical problems.” It also includes coding and payment arrangements for some new services to help those who don’t. This includes offering to pay for certain caregiver training services under certain circumstances, and introducing separate coding and payment for community health integrated services.
The Cancer Moonshot Provision provides anyone diagnosed with cancer with services (care involving peer support professionals) to help patients progress to treatment for cancer and other serious illnesses. ), we aim to ensure that you have access to These changes also include proposals for the availability of coding and payment for social determinants of health (SDoH) risk assessments, either as an addition to annual health visits or as an assessment. and management (E&M) visit.
A press release on the proposed rule issued by CMS describes the new proposed access to oral and dental care services for beneficiaries, supporting patients’ “emotional and mental well-being through behavioral health care,” and the U.S. Health and Human Services. Ministry is also mentioned. (HHS) Initiatives to Strengthen Primary Care.
“CMS also continues to promote whole person care in the Medicare Shared Savings Program, the nation’s largest accountable care organization (ACO) program,” the release reads. “CMS is proposing a change in deployment that will better facilitate access to responsible care for individuals who see nurses, physician assistants and clinical nursing professionals for primary care services. It also proposes changes to the financial benchmarking methodology to better facilitate the participation of ACOs serving complex populations.In total, these proposals would increase participation in shared savings programs by approximately 10-10%. We anticipate a 20 percent increase, which will provide additional opportunities for beneficiaries to receive coordinated care from the ACO.”
In a related announcement, CMS said it was looking to enhance the Medicare Diabetes Prevention Program (MDPP) expansion model to further increase participation and access to underserved communities. The proposal would extend public health emergency (PHE) flexibility by four years, with officials saying all MDPP suppliers will continue to extend distance learning delivery through 2027 as long as they maintain in-person disease control centers. It is said that the provision of the virtual MDPP service used can be continued. and prevention (CDC) organization code.
A 60-day comment period for the OPPS draft rule will end in mid-September, followed by a final rule release in November. In addition to the payment rate proposal, the rule also included policy proposals that overlapped somewhat with the PFS plan. “Promote health equity, expand access to behavioral therapies, increase transparency in health care systems, promote safe and effective patient-centred care, and address health product shortages.”
The OPPS policy will affect about 3,500 hospitals and about 6,000 ambulatory surgery centers (ASCs), while the proposed hospital price transparency policy will affect more than 7,000 facilities licensed as hospitals, officials said. .
The new OPPS payout rate for hospitals meeting applicable quality reporting requirements represents a net 2.8% increase.
“The 2019 OPPS/ASC final rule with comment period finalized policy to apply the updated productivity-adjusted hospital market basket to ASC payment system fees for a five-year interim period (2019-2023). “There will be a time to assess whether there will be a shift in the implementation of procedures from hospital settings to ASC settings as a result of the use of productivity-adjusted hospital market basket updates,” CMS said in a fact sheet. said in “However, especially in 2020, the impact of COVID-19 PHE on healthcare utilization will be particularly significant as many beneficiaries avoided healthcare settings as much as possible to avoid possible SARS-CoV infection. The 2024 OPPS/ASC rule proposal, therefore, proposes to extend the 5-year interim period by an additional 2 years through 2024 and 2025. This will allow us to collect additional billing data that is further removed from the impact of COVID-19.19 PHE said the application of the hospital market basket update to its ASC payment system will help it move from the hospital environment to the ASC environment. We need a more accurate analysis of whether it has impacted the migration of our services.”
The proposed OPPS rule also includes a proposal to establish an Intensive Outpatient Program (IOP) under Medicare, including coverage of benefits, physician certification requirements, coding and billing, and payout rates under IOP benefits. It is Once finalized, IOP services will be provided in hospital outpatient departments, Community Mental Health Centers (CMHC), Federally Qualified Health Centers (FQHC), and Rural Health Clinics (RHCs) and will be part of the “Community Behavioral Health Insurance Program”. Addressing one of the major gaps”. Medicare. ”
In a related move, CMS is also proposing to establish two IOP Outpatient Payment Classifications (APCs) for each type of provider. One for daily with 3 services per day and one for daily with 4 or more services per day.
Dr. Ronald Hirsch, vice president of R1 RCM Inc.’s Regulatory and Education Group and a regular on the weekly Internet radio broadcast Monitor Mondays (and a longtime contributor to RACmonitor), said the OPPS announcement was a number of He said he was remarkably silent on the matter. I hope the industry is addressed.
“For Monitor Mondays listeners and RACmonitor eNews readers, …the proposed rule makes no material changes, there are no changes to the 2:00 midnight rule, no case-by-case exceptions are mentioned, There has also been no removal from the Inpatient Only List (IOL), and only a few codes have been proposed to be added to the IOL for newly assigned codes such as HCPCS 0646T Transcatheter Tricuspid Implantation.” Hirsch says. “On the other hand, CMS appears unsatisfied with the efforts hospitals have made to comply with price transparency rules and is proposing significant changes to its requirements and enforcement methods.”
To view the 2024 Proposed Physician Compensation Schedule Rule Fact Sheet online, please visit: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proused-rule
To view the Fact Sheet on the 2024 OPPS Rule Proposals, please visit: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
Mark Spivey is a National Correspondent for RACmonitor and ICD10monitor and has written and edited material on federal oversight of American healthcare for nearly 15 years. Contact him at [email protected].
