CMS continues to make gradual adjustments to hospital payment system and schedules, among the changes are codes added for remote patient monitoring services.
November 7, 2017 by Frost Brown Todd
As usual, this year CMS did not disappoint, having just issued several final rules for the Physician Fee Schedule (PFS), as well as the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System and Outpatient Quality Reporting (OQR) Programs, all of which contain a number of new rules and initiatives affecting hospitals. (For information on new CMS rules affecting physicians, please see Top Takeaways for Medicare Physician Payments in 2018.)
One component of the OPPS Rule that was quickly attacked was the reduction in 340B drug payments to certain hospitals, including critical access hospitals and public and nonprofit disproportionate share hospitals. Under this policy, CMS will pay for separately-payable, “nonpass-through” drugs and biologicals (other than vaccines) purchased through the 340B program at the average sales price (ASP) minus 22.5%, rather than the prior payment rate of ASP plus 6%.
CMS indicated its motivation for this change is to “address recent trends of increasing drug prices, for which some of the cost burden falls to Medicare beneficiaries.” CMS indicated it will implement this policy in a budget-neutral manner “by offsetting the projected decrease in drug payments of $1.6 billion by redistributing an equal amount for non-drug items and services across the OPPS.”
Regardless of CMS’ plan for “redistributing” these costs, the dramatic 28.5% reduction was all but certain to be denounced by providers. In fact, the response from the three major hospital associations was rather swift. Within an hour after the Rule was released, they jointly indicated their intention to file a lawsuitclaiming CMS has overstepped its statutory authority by making such a change. They also stated that the change will put safety-net hospitals at particular risk, as 340B hospitals provide 60% of uncompensated care, even though the make up only 36% of U.S. hospitals.
Other items of interest for hospitals in the new Rules: