CMS final rule implements site-neutral payments, AHA files legal challenge: 5 things to know

The American Hospital Association is not happy about CMS' plans to issue site-neutral payments for outpatient care, and the organization plans to file a legal challenge against the agency's final rule, which was issued Nov. 2, according to Medscape.


Here are five things to know:

1. Under the 2019 final rule, CMS will reimburse physicians at hospital-owned off-campus clinics "at a rate equivalent to that for physicians in the community who are not affiliated with a hospital," according to the report. Previously, hospital-owned off-campus clinics received a higher rate than non-affiliated clinics.

2. The new policy cuts Medicare reimbursement to the off-campus sites by around 60 percent, and potentially saves Medicare $380 million in 2019. Copays would decrease by $7 to $16 per visit regardless of the site of service, according to the report.

3. The AHA is against the change, and in a statement following the final rule's release last week said it would have "negative consequences" for patients, potentially hurting a hospital's ability to modernize and provide services in underserved communities. The organization cites a study conducted by KNG Health Consulting showed that hospital outpatient department patients are typically poorer and arrive with more serious chronic conditions than those who seek treatment at independent physician offices.

4. The AHA also opposed aspects of the final rule that expand the 30 percent payment cuts for 340B drugs to additional sites of care.

"These actions clearly exceed the administration's legal authority. The AHA, joined by the Association of American Medical Colleges and member hospitals, intends to promptly bring a court challenge to the new rule's site-neutral provisions," according to the AHA statement.

5. The Trump administration has been signaling this change for several months now, including a statement from CMS Administrator Seema Verma during a discussion at the Commonwealth Club of California in July. She outlined the agency's stance on site-neutral payments: "Medicare pays for things differently based on the site of care, paying more or less for the same service but at different locations. Now sometimes it makes sense, as some facilities provide a higher level of service. But other times, it creates misaligned incentives; decisions about whether a patient receives a service in a hospital or a doctor's office is influenced by how Medicare pays."

The Ambulatory Surgery Center Association applauded the final rule's movement toward site-neutral payments.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Featured Podcast