On November 2, the Centers for Medicare & Medicaid Services (CMS) released the outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) final rule for calendar year (CY) 2011. The final rule takes effect January 1, 2011.
In addition to updating OPPS and ASC payment weights and rates, the rule includes both OPPS and inpatient PPS changes enacted by the Patient Protection and Affordable Care Act (ACA). The inpatient issues include graduate medical education (GME) and physician self-referral regulation changes. The GME provisions in the final rule will be addressed in a separate AHA Regulatory Advisory.
AHA has distributed an advisory examining the OPPS/ASC final rule. Major provisions include:
- A mandated 0.25 percentage point reduction to the CY 2011 marketbasket update of 2.6 percent, resulting in a productivity-adjusted marketbasket update of 2.35 percent.
- Changes to the physician supervision policy including no enforcement in CY 2011 of the direct supervision policy for therapeutic services provided in critical access hospitals (CAHs) and in small rural PPS hospitals with 100 or fewer beds; a revised definition of "direct supervision" that allows more flexibility in the physical location of the supervising professional and a reduced level of supervision for certain outpatient therapeutic services, including observation and certain infusions and injections.
- The addition of four new quality measures for 2012 and eight for 2013 and a quality data validation process similar to the one recently instituted for the inpatient program.
- A waiver of beneficiary cost-sharing for most Medicare-covered preventive services.
- A decision to not finalize the proposed payment adjustment for 11 cancer hospitals.
If you are an MHA member and would like a copy of this advisory, email Shawn Rossi at srossi@mhanet.org.
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