By Virgil Dickson | July 25, 2018
In a massive outpatient
payment rule, the CMS on Wednesday proposed expanding its site neutral payment
policy to clinic visits, a move that could save the agency hundreds of millions
of dollars.
Clinic visits, or checkups, are the most common service billed under the outpatient pay rule. The CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.
If finalized, the payment change is projected to save Medicare $610 million and patients about $150 million via lower co-payments for doctor visits provided at an off-campus hospital outpatient department.
Overall, outpatient departments will get $90 million or 1.25% more than they got in 2018. That's down from a $690 million increase from last year, which included some redistribution of 340B funds.
The CMS also wants to expand last year's cuts to 340B discounts given to outpatient facilities. If that proposal is finalized, the CMS estimates that Medicare and its beneficiaries would save approximately $48.5 million from the change.
Last year, the agency cut 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.
In 2018, patients saved about $320 million on out-of-pocket payments for these drugs, as a result of the change according to the CMS.
The CMS said in its notice "a few commenters raised that the 340B reduction would not apply to non-excepted off-campus PBDs and shared their view that this could result in behavioral changes that may undermine CMS' policy goals of reducing beneficiary cost-sharing liability."
The proposed rule suggested closing a potential loophole that allows providers to bill patients more for visits in hospital outpatient departments when they create new service lines.
The rule also expands the number of procedures payable at ambulatory surgical centers.
Finally, the CMS is seeking comments on whether providers and suppliers should be required to inform patients about charge and payment information for healthcare services and out-of-pocket costs, what data elements would be most useful to promote price shopping and what other changes are needed to empower healthcare consumers.
Story developing...
Clinic visits, or checkups, are the most common service billed under the outpatient pay rule. The CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.
If finalized, the payment change is projected to save Medicare $610 million and patients about $150 million via lower co-payments for doctor visits provided at an off-campus hospital outpatient department.
Overall, outpatient departments will get $90 million or 1.25% more than they got in 2018. That's down from a $690 million increase from last year, which included some redistribution of 340B funds.
The CMS also wants to expand last year's cuts to 340B discounts given to outpatient facilities. If that proposal is finalized, the CMS estimates that Medicare and its beneficiaries would save approximately $48.5 million from the change.
Last year, the agency cut 340B drug payments by $1.6 billion, or 22.5% less than the average sales price.
In 2018, patients saved about $320 million on out-of-pocket payments for these drugs, as a result of the change according to the CMS.
The CMS said in its notice "a few commenters raised that the 340B reduction would not apply to non-excepted off-campus PBDs and shared their view that this could result in behavioral changes that may undermine CMS' policy goals of reducing beneficiary cost-sharing liability."
The proposed rule suggested closing a potential loophole that allows providers to bill patients more for visits in hospital outpatient departments when they create new service lines.
The rule also expands the number of procedures payable at ambulatory surgical centers.
Finally, the CMS is seeking comments on whether providers and suppliers should be required to inform patients about charge and payment information for healthcare services and out-of-pocket costs, what data elements would be most useful to promote price shopping and what other changes are needed to empower healthcare consumers.
Story developing...
Virgil Dickson reports from
Washington on the federal regulatory agencies. His experience before joining
Modern Healthcare in 2013 includes serving as the Washington-based
correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned
a bachelor's degree from DePaul University in 2007.
http://www.modernhealthcare.com/article/20180725/NEWS/180729939?utm_source=modernhealthcare&utm_medium=email&utm_content=20180725-NEWS-180729939&utm_campaign=dose
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