Outpatient site-neutral pay pitched (again) to CMS: 5 notes

MedPAC advocated for site-neutral pay for 66 outpatient procedures in a June 15 report, lowering 57 procedures to the office-based care rate and nine procedures to ASC rates.

Five things to know:

1. MedPAC said site-neutral pay for select procedures would prevent some consolidation, remove financial incentives for site-of-service decisions and eventually save billions of dollars for the healthcare system.

2. To determine pay rates, MedPAC identified 66 services most common in office-based practices and ASCs to align HOPD rates. The nine services most common in ASCs includes:

  • Level 2 lower GI procedures
  • Level 1 intraocular procedures
  • Level 1 nerve procedures
  • Level 1 lower GI procedures
  • Level 2 intraocular procedures
  • Level 2 musculoskeletal procedures
  • Level 2 neurostimulator and related procedures
  • Level 3 extraocular repair, and plastic eye procedures
  • Level 4 extraocular, repair and plastic eye procedures

3. The site-neutral pay recommended by MedPAC would have saved Medicare $7.75 billion in 2021, according to the report.

4. MedPAC's recommendation would lower pay rates for 57 procedures in the ASC that are currently most common in HOPDs.

5. The American Hospital Association released a statement opposing the plan, noting it would hit struggling rural hospitals the hardest.

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


Featured Webinars

Featured Whitepapers

Featured Podcast