CMS proposes 2.15% increase in HOPPS

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a 2.15% increase in hospital outpatient payments for calendar year 2011, the agency said.

In a proposed update of rates to its Hospital Outpatient Prospective Payment System (HOPPS), CMS incorporated changes required by the Affordable Care Act of 2010, including a 0.25 percentage point reduction to the fee schedule increase factor for outpatient hospital services. The estimated hospital increase factor is 2.4% for 2011; less the 0.25 percentage point reduction, the payment rate increase will be 2.15%.

The proposed rule would also update policies and payment rates for services in Medicare-participating ambulatory surgical centers (ASCs), under a payment system that aligns ASC payments with payments for the corresponding services in hospital outpatient departments (HOPDs), making 2011 the first year that the revised ASC payment system rates will be fully put in place, CMS said. CMS estimates the ASC conversion factor for 2011 at 1.6%; but also in 2011, the Affordable Care Act requires the annual update factor for the ASC payment system to be reduced by a productivity adjustment, which is also estimated to be 1.6%. Therefore, CMS is proposing no percent update to the ASC payment system.

The agency projects total Medicare payments of approximately $40 billion to HOPDs and $4 billion to ASCs for 2011.

In addition, CMS is proposing to add six quality measures to the current list of 11 to be reported by HOPDs. The new measures include four claims-based imaging efficiency measures.

CMS will take comments until August 31, 2010. A final payment rule will be issued November 1.

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