CMS Releases Final OPPS Rule, Incorporates Recommended Changes - November 8, 2011

On Nov.1, the Centers for Medicare & Medicaid Services (CMS) released the hospital outpatient prospective payment system (OPPS) final rule for calendar year (CY) 2012. NAPH is pleased that CMS adopted many of the changes recommended in our Aug. 30 comment letter to CMS.

For CY 2012, CMS finalized an OPPS fee schedule increase by a factor of 1.9 percent, which is a 0.4 percentage point increase over the proposed rule. CMS also revised its proposed Medicare inpatient Value-Based Purchasing Program fiscal year (FY) 2014 requirements by suspending the effective dates of the nonmortality outcome measures and the efficiency measure. NAPH had argued that these measures be delayed since data will not have been publicly available on Hospital Compare for at least 1 year prior to the performance period, as required by the Affordable Care Act.

Additionally, NAPH is pleased that CMS decided against finalizing six of the nine proposed Outpatient Quality Reporting (OQR) Program measures (one surgical site infection measure and five diabetes measures) for CY 2014. CMS agreed with NAPH’s comments that the surgical site infection measure has not been thoroughly tested and specified in the outpatient environment and that the five diabetes measures lacked detailed measure specifications and would overburden providers. For the CY 2015 payment determination, CMS agreed with NAPH’s recommendation to not finalize its proposed influenza vaccination coverage measure. More information can be found in NAPH’s Special Update (members only), released on Nov. 3.