According to the proposed Outpatient Prospective Payment System (OPPS) rule for 2021, Medicare outpatient cost will see an increase of 2.6%. The proposed rule that CMS released on Tuesday estimates total payments to providers will increase to almost $84 billion in 2021. The trade-off would be hospitals acquiring outpatient drugs through the 340B Drug Pricing Program would be lower.
The proposed rule would revise the OPPS and the Medicare ambulatory surgical center (ASC) payment system for 2021 based on continuing experience with these systems. The rule would also update and refine requirements for the Hospital Outpatient Quality Reporting Program as well as the ASC Quality Reporting Program.
CMS Working to Lower Cost Where it Can
“We propose for CY [calendar year] 2021 and subsequent years to pay for drugs acquired under the 340B program at ASP minus 34.7 percent, plus an add-on of 6 percent of the product’s ASP, for a net payment rate of ASP minus 28.7 percent based on the results of the Hospital Acquisition Cost Survey for 340B-Acquired Specified Covered Drugs,” CMS stated in the proposed rule. These rules are to help continue CMS’ recent focus on site-neutral payment policies while getting rid of the inpatient-only list. The plan would be to phase out the Inpatient Only (IPO) Procedures List by 2024.
“We agree with past commenters that the physician should use his or her clinical knowledge and judgment, together with consideration of the beneficiary’s specific needs, to determine whether a procedure can be performed appropriately in a hospital outpatient setting or whether inpatient care is required for the beneficiary, subject to the general coverage rules requiring that any procedure be reasonable and necessary,” CMS writes in the rule. If passed by eliminating inpatient-only status the pricing for certain procedures will continue to drop. These procedures will become more common in ambulatory surgery centers, taking business away from acute care hospitals. The payment increase would also help compel ambulatory surgical centers to do these surgeries more.
340B Drug pricing reduction
With the 340B Drug pricing reduction, the law is intended to allow hospitals to purchase drugs from manufacturers at a discounted rate to accommodate uninsured and low-income patients. Details of the price reduction were vague, but the numbers CMS came up with relays an even bigger reduced price than previous numbers.
What do you think about the proposed rule? Leave your comments below!
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