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While surgery centers support CMS payment proposal, hospital groups submit harsh criticism — 5 takeaways

Hospital groups, surgery centers and individuals submitted comments to CMS about its proposed changes to the hospital outpatient prospective payment system, ASC payments and the 340B drug program, AJMC reports.

Here are five takeaways:

1. CMS said the changes are meant to address hospitals' and providers' concerns about healthcare consolidation and save several millions of dollars. The changes entail expanding site-neutral payments and extending 340B drug discounts to off-site hospital clinics.

2. Surgery centers submitted comments supporting the proposal. The Surgical Economic Think Tank, a group representing individual private practice surgeons, applauded the part of the proposal designed to shift more services to ASCs.

"Prudent use of financial resources for the Medicare Program does not permit a higher payment for one setting over another," the group wrote.

3. In contrast, the American Hospital Association, America's Essential Hospitals and other hospital groups submitted harshly critical comments.

They took issue with CMS's plan to pay nonexcepted off-campus hospital clinics average sales price minus 22.5 percent for drugs obtained through the 340B program, as well as the plan to reduce reimbursement for hospital outpatient clinic visits in certain off-campus provider-based departments. Payments would match the physician fee schedule rate, which is 40 percent of the OPPS rate.

4. The hospital groups also opposed setting payments for services from expanded clinical families in certain off-campus PBD at 40 percent of the OPPS rate. Hospitals would be required to make operational and administrative changes by Jan. 1, 2019.

5. Port Angeles, Wash. Olympic Medical Center patients and staff wrote individual letters warning the changes would have a devastating financial impact on the rural hospital. A Texas rheumatologist said the payment changes would make it impossible to address her patients' complex medical issues, forcing her to consider early retirement.

More articles on coding, billing and collections:
Simple Pay to help patients pay for healthcare — And help surgery centers collect
North Carolina court ruling aligns workers' compensation reimbursement costs at ASCs with national average
Outpatient coders improve ICD-10 accuracy scores, but inpatient keeps the crown: 5 contest takeaways

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