DHPA filed comments in response to CMS’s interim final rule implementing the site-neutrality payment provisions in the Bipartisan Budget Act of 2015 (BBA).
Congress enacted provisions in the BBA to “curb the practice of hospital acquisition of physician practices,” whereby hospitals acquire physician groups or ASCs, designate them “off-campus, provider-based departments” and bill for services under the higher Outpatient Prospective Payment System (OPPS) fee schedule. In Section 603 of the BBA, Congress provided that any off-campus, provider based department (PBD) acquired after November 1, 2015, would be paid under an “applicable payment system” other than the OPPS. The clear aim of the statute was to eliminate, on a prospective basis, the payment differential for identical services furnished in independent practices/ASCs versus the hospital out-patient setting. The statute was not long on details, however, and it was left to CMS to flesh out the specifics in implementing regulations.
DHPA agreed with certain steps CMS has taken to establish a more level playing field across sites of service, but there are ways in which CMS’s interim final rule fails to meet Congress’s goal of achieving a site-neutral payment structure between off-campus PBDs and independent physician practices. Certain aspects of the interim final rule will perpetuate the payment disparity between off-campus PBDs and independent physician practices that furnish identical services, placing even great financial pressure on Medicare beneficiaries and the healthcare system as a whole.
Accordingly, CMS should take the following steps to eliminate payment disparities between sites-of-service, thereby reducing hospitals’ incentives to continue acquiring physician practices:
- CMS should limit the items and services that an excepted PBD may bill under the OPPS to those items and services for which the PBD actually billed between November 2, 2014 and November 2, 2015.
- CMS should reverse its interim final policy of allowing nonexcepted PBDs to receive a unique facility fee under the MPFS.
- CMS should prioritize making the operational changes needed in order to adopt a truly site neutral payment policy for future years that establishes equivalent levels of reimbursement for identical services between nonexcepted PBDs and physician offices.
Click here to read the full comment letter.