DCMedical News: Tuesday, July 20, 2021
DCMedical News-DCMN
Washington, D.C.
Tuesday, July 20, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY
The Third of the “Big Three” of Health Care Payment and Regulatory Structures Now Published
The CY 2022 Outpatient Prospective Payment System (OPPS) proposed Rule was made available (863 pgs., here; Medicare Learning Network summary here; CMS fact sheet here) yesterday, in advance of the planned August 14 publication in the Federal Register.
The OPPS Rule joins the proposed IPPS Rule (comment period ended June 28, HFMA comments here) and the CY 2022 Physician Fee Schedule (PFS, see below) as Medicare’s payment encyclopedia for doctors, hospitals, ambulatory surgery centers and some others, also setting a template for future adoption by commercial health insurers.
Much of the early attention was focused on “price transparency” Rules (CQ here, Bloomberg here, Modern Healthcare coverage here), and an increase in penalties for hospitals not complying with the price Rules.
From the CMS fact sheet, “CMS proposes to set a minimum CMP [Civil Monetary Penalty] of $300/day that would apply to smaller hospitals with a bed count of 30 or fewer and apply a penalty of $10/bed/day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. Under this proposed approach, for a full calendar year of noncompliance, the minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital. CMS is seeking comment on alternative or additional criteria that could be used to scale a CMP such as: hospital revenue; the nature, scope, severity, and duration of noncompliance; and the hospital's reason for noncompliance.”
Other important parts of the proposed Rule increase the rate of payment by Medicare for hospital outpatient services (and for ambulatory surgery centers, ASCs) by 2.3% (nearly $11 billion). MedPAC had recommended no increase for ASCs until they began reporting costs, as hospitals do, but CMS has made no apparent progress in developing a cost reporting system which would “relieve the burden” of such reports on the centers, and asked instead (in the proposed Rule) for “input.”
In an extraordinary mea culpa, and one of import to both ASCs and hospitals, the CMS fact sheet reports “The agency is proposing to halt the phased elimination of the Inpatient-Only (IPO) list—procedures that Medicare will only make payment for when provided in the inpatient setting. There are some services designated as inpatient only that, given their clinical intensity, would not be expected to be performed in the outpatient setting. CMS adopted a policy for 2021 to eliminate this list over a phased period and removed musculoskeletal procedures from the list in 2021.”
The fact sheet continues, “This change happened without individually evaluating whether the procedures met the long-standing criteria previously used to determine if a procedure could be safely removed. Some of the musculoskeletal services removed includes services like limb amputations and invasive spinal procedures. CMS reviewed each procedure code of services that were removed and found none met criteria for removal, with insufficient supporting evidence that the service can be safely performed on the Medicare population in the outpatient setting.” (Italics added.)
CMS is also seeking nominees from the public (!) concerning current hospital only procedures which can be safely performed in ASCs.
DOCTORS, NURSES AND OTHER HEALTH CARE PROFESSIONALS
Physician Fee Schedule Publication Stirs Comment
The CY 2022 Medicare proposed Rule for Physician Fee Schedules (PFS, 1747 pgs., here; reports from Bloomberg, here, CQ here, Medicare Learning Network here, Modern Healthcare here, Radiology Business reaction here) would bring changes in telehealth, mental health payment, “quality” bonus payments and a reduction in the “conversion factor” which translates relative value units into dollar amounts.
CQ reports, “If finalized, the Rule would pay doctors for seeing mental health patients virtually from their homes if the patients have had an in-person appointment within the past six months and are seen once every six months thereafter. The change was passed as part of the fiscal 2021 spending law (PL 116-260).”
Also, “Doctors would also be allowed to treat mental health patients over the phone as long as they have the capability to conduct video calls when the patient prefers. Providers participating in an opioid treatment program could also conduct phone calls with patients if they do not consent to video calls or if the technology is unavailable to them.”
The Rule also proposes a one-year freeze on performance requirements for doctor groups participating in accountable care organizations with opportunities for bonus payments . . .But the Rule would increase requirements for doctors to receive bonus payments through a broader quality program under the Medicare Access and CHIP Reauthorization Act (PL 114-10). That program requires more burdensome data reporting, and CMS is proposing its first set of measures aimed at streamlining the administrative workload. The reporting targets care related to rheumatology, strokes, heart disease, chronic disease management, joint replacements, emergency medicine, and anesthesia.”
Primary Care, Private Equity, a “Staggering” Increase in Acquisitions
Modern Healthcare reports (here) that a survey of investors buying physician practices by “Solic Capital Management tallied total transaction value of $126.1 billion in the three months ended June 30, which the firm characterized as a ‘staggering’ increase over the $12.9 billion announced during the same period in 2020.”
The physician practice acquisitions were “a shift from five years ago, when buyers were mostly health systems . . . The hottest area for investment as of late is primary care, a surprising finding given that private equity tends to favor specialties with higher reimbursement like dermatology, ophthalmology and orthopedics. Primary care also tends to have higher proportions of Medicare and Medicaid patients than specialties that draw more commercially insured clientele. What makes primary care so attractive right now is the aging Baby Boomer generation and the continued expansion of Medicare Advantage.”
READINGS & REFERENCES
Eli Adashi and Glenn Cohen discuss (here) a broader view of the American Rescue Plan Act of 2021 (ARPA), which they call “A Historic if Transitory Expansion of the ACA.” They note that expanding health insurance marketplace subsidies, defraying the health insurance costs of the unemployed, and further incentivizing the “non-expansion” states to expand Medicaid programs, combine to emulate a national health (insurance) policy.
Select Coronavirus Public Health Resources and References (alphabetical) may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
July 21, 22, 26, 27, 28, 29, 30
August - none
September 20, 21, 22, 23, 24, 27, 28, 29, 30
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.