2010-07-07

On July 2, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule governing payment policies and rates for the hospital outpatient payment system (OPPS) for calendar year 2011. ASH has developed a detailed analysis of the key issues and potential impact on hematology. The proposed rule would update policies and payment rates for the more than 4,000 hospitals that provide hospital outpatient services to Medicare beneficiaries and for the approximately 5,000 Medicare-participating Ambulatory Surgery Centers.

The rule proposes an update in the OPPS conversion factor of 2.15 percent, except for hospitals that do not successfully report quality measures, which will receive an update of only 0.15 percent. In addition, the rule expands the number of hospital outpatient quality measures that must be reported and revises current policies regarding physician supervision of services provided in the hospital outpatient setting. Of interest to hematologists, CMS plans to evaluate its current reimbursement for stem cell acquisition when performed in conjunction with recipient transplantation and preparation of tissue.

The proposed rule also includes proposals to implement several provisions of the Affordable Care Act (the recently enacted health reform legislation), including those related to graduate medical education. The new law requires CMS to identify unused residency slots and redistribute them with an emphasis on increasing the number of primary care physicians and specifies how CMS is to count hours spent by a resident in certain training and research activities, as well as how to count hours spent by a resident in patient care activities in a non-hospital setting, such as a physician’s office.

ASH will submit comments to CMS, which by the August 31 deadline. ASH members who have concerns about the proposed rule should contact ASH Senior Manager, Policy and Practice Carol Schwartz, at 202-776-0544.

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