CMS releases proposal for 2016 hospital outpatient payments

Next year, hospitals will receive slight reductions in outpatient payments when treating Medicare patients, while the "two midnight" rule will be maintained, according to a proposed rule from the Centers for Medicare & Medicaid Services (CMS).

As part of the proposed Hospital Outpatient Prospective Payment System (HOPPS), CMS announced hospitals will receive a 0.2 percent decrease in outpatient payments. CMS also will not make changes to its “two midnight” rule, the policy that says surgical procedures, diagnostic tests and other inpatient treatments are appropriate for inpatient Medicare Part A payments if patients remain hospitalized for at least two midnights.

However, the American College of Cardiology (ACC) noted that CMS made changes to its exceptions policy that allows Medicare Part A payments for inpatient admissions that do not satisfy the “two midnight” rule on a case-by-case basis as judged by the admitting physician. Under that rule, any time a patient spends in the inpatient setting is not considered for outpatient payment.

The ACC also mentioned CMS wants to use quality improvement organizations to oversee the majority of patient status audits and educate doctors and hospitals about Medicare Part A policies regarding inpatient admissions.

In 2016, CMS proposes expanding its list of packaged payments for ancillary services to include cardiac drug stress tests, electrocardiogram monitoring and reporting up to 48 hours. The ACC said CMS wants to package bivalirudin and abciximab into the Ambulatory Payment Classification (APC) payment for percutaneous coronary intervention procedures. It also proposes adding nine comprehensive APCs.

Starting in 2017, hospitals will have their payments reduced 2 percent per year if they do not meet the requirements under the Hospital Outpatient Quality Reporting Program. CMS is seeking to align that program with the Ambulatory Surgical Center Quality Reporting Program.

CMS is accepting comments on the “two midnight” rule until Aug. 31. The final rule will be released by Nov. 1.