Posted byOrthoEx Posted in
Posted on Jul 26, 2018

By Sara Heath

 – CMS has proposed changes to the Medicare Hospital Outpatient Prospective Payment System (OPPS) to create site-neutral payments, thus allowing senior patients to access the care they need in their preferred care site.

Creating site-neutral payments for Medicare patients would allow CMS to reimburse the same amount of clinic visits in hospital outpatient settings as in the physician office setting.

Currently, CMS must reimburse more for clinic visits, which the agency defines as “essentially check-ups with a clinician,” in outpatient hospital settings than in physician office settings, despite the fact that the agency says both providers are delivering the same type of care.

Making site-neutral payments will give patients the freedom to seek clinical care at whichever care site they choose without large financial implications for the Medicare program, the agency said.

The change could also have positive impacts on patients, saving them nearly $150 on copayments for visits in outpatient hospital settings.

CMS also proposed extending site-neutral payments to other sites of care, creating more patient freedom. Specifically, CMS proposes to:

  • Expand the number of procedures payable at ASCs to include additional procedures that can safely be performed in that setting;
  • Ensure ASC payment for procedures involving certain high-cost devices parallels the payment amount provided to hospital outpatient departments for these devices; and
  • Help ensure that ASCs remain competitive by stabilizing the differential between ASC payment rates and hospital outpatient department payment rates.

This most recent CMS announcement also proposed changes to the pharmaceutical landscape both as it relates to rising drug costs and combatting the opioid crisis.