CMS Proposes Updated Payment Policies

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and payment rates for services furnished to Medicare beneficiaries in hospital outpatient departments and ambulatory surgical centers (ASCs) beginning Jan. 1, 2012.

“The CMS is committed to using every tool at its disposal to create incentives that will improve the quality and safety of care received by Medicare beneficiaries, wherever that care is provided,” Donald M. Berwick, MD, CMS Administrator, stated in a CMS press release.

The proposed rule also contains proposals that would strengthen the Hospital Value-Based Purchasing (HVBP) Program. The HVBP Program, which was required by the Affordable Care Act of 2010, will tie a portion of a hospital’s payment for inpatient stays under the Inpatient Prospective Payment System in fiscal year 2014 to its performance score on a set of quality measures. CMS issued a final rule establishing this program in April.

CMS is also proposing changes to the Medicare Electronic Health Record Incentive Program that would allow eligible hospitals and critical access hospitals to report clinical quality measures for 2012 by participating in an electronic reporting pilot.

CMS projects that total payments to more than 4,000 hospitals — including general acute care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, long-term acute care hospitals, children’s hospitals and cancer hospitals — under the Outpatient Prospective Payment System in calendar year 2012 — will be approximately $41.9 billion. CMS also projects that payments to approximately 5,000 Medicare-participating ASCs under the ASC Payment System will be approximately $3.61 billion.

The proposed rule would continue to strengthen the Hospital Outpatient Quality Reporting Program and for the first time establish a quality reporting program for ASCs.

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