Final Rules – OPPS & ASC for CY2012, Value-Based Purchasing, Physician Self-Referral; & Patient Notification Requirements
CMS-1525-FC; Posted 11/01/11; FR 11/30/11
Excerpts from CMS E-mail:
…CMS projects that total payments to more than 4,000 hospitals – which includes general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals, and cancer hospitals – paid under the Outpatient Prospective Payment System (OPPS) in CY 2012 will be approximately $41.1 billion. CMS also projects that payments to approximately 5,000 Medicare-participating ASCs paid under the ASC Payment System will be approximately $3.5 billion for CY 2012.
…The final rule also establishes an electronic reporting pilot that will allow additional hospitals, including critical access hospitals (CAHs), to report clinical quality measures in CY 2012 for purposes of participating in the Medicare Electronic Health Record Incentive Program.
Provisions affecting payments to Hospital Outpatient Departments
The final rule will increase payment rates under the OPPS by 1.9 percent in CY 2012. This increase is based on the projected hospital inpatient market basket percentage increase of 3.0 percent for inpatient services paid under the Hospital Inpatient Prospective Payment System (IPPS) minus the multifactor productivity adjustment of 1.0 percentage points and minus a 0.1 percentage point adjustment, both of which are required by the Affordable Care Act.
The final rule also provides a payment adjustment for designated cancer hospitals as required by the Affordable Care Act. This payment adjustment is expected to increase payments to cancer hospitals by 11.3 percent (or approximately $71 million) over what they would have otherwise been paid…
Provisions affecting payments to Ambulatory Surgical Centers
The final rule increases payment rates to ASCs by 1.6 percent in CY 2012. This reflects a consumer price index for all urban consumers estimated at 2.7 percent, minus a 1.1 percent productivity adjustment required by the Affordable Care Act.
The final rule also establishes a quality reporting program for ASCs and adopts five quality measures, including four outcome measures and one surgical infection control measure beginning in CY 2012 for the CY 2014 payment determination…
Provisions affecting the Hospital Value-Based Purchasing program
The Hospital VBP, which was required by section 3001(a) of the Affordable Care Act, was initially established in a final rule published in May 2011. The final rule contained the measures, performance standards, and scoring methodology that would be used to determine the value-based incentive payments to hospitals in FY 2013. The final rule announced today addresses the program requirements for the FY 2014 program. These changes include: adding one clinical process measure to guard against infections due to urinary catheters; and, establishing the weighting, performance periods, and performance standards for the clinical process, patient experience, and outcomes measures for FY 2014.
