Site-Neutral Cuts Largely Intact in Final 2019 OPPS Rule Released by CMS

WHA Urges Congress to Act to Reverse Cuts

November 06, 2018

The Centers for Medicare & Medicaid Services (CMS) released its Final 2019 Outpatient Prospective Payment System (OPPS) Rule on Friday, November 2, keeping its proposal to cut clinic visit payments for off-campus hospital outpatient departments largely intact. WHA had expressed strong concerns to CMS over this policy, and spearheaded a letter signed by seven of Wisconsin’s 10 Congressional members, urging CMS to reverse the proposed cuts. 

In response, CMS delayed the full effect of the proposed cuts for clinic visits in off-campus hospital outpatient departments by phasing them in over two years. In 2019, reimbursements for clinic visits will go to 70% of current levels. They will go to 40% in 2020 and subsequent years. CMS also decided not to reduce payments to new families of services in hospital outpatient departments, though it essentially warned it would consider reducing those payments in subsequent rules.

In a letter sent to Wisconsin’s Congressional Delegation on November 6, WHA President & CEO Eric Borgerding called CMS’s response woefully inadequate, while expressing WHA’s continued strong objections to this policy. Borgerding notes that Wisconsin hospitals would still be expected to absorb $15 million in cuts next year with less than two months before they take effect, not to mention more than $30 million annually in subsequent years. Recognizing that these cuts go against two previous acts of Congress that grandfathered previously participating hospitals at the current payment structure, Borgerding urged Congress to act swiftly to correct this massive overreach by CMS.

WHA’s comment letter also asked CMS to use its authority to restore fairness to the area wage index in the OPPS rule. A provision in the Affordable Care Act (ACA) known as the “Bay State Boondoggle” created massive unfair distortions in the wage index that largely benefit hospitals on the east and west coasts at the expense of all other hospitals. While CMS agreed with WHA that it had the authority to apply a different wage index under the OPPS than is required by the ACA for the inpatient payment rule, it decided not to make any changes, arguing that would add “administrative complexity that is burdensome and unnecessary.” WHA will continue to advocate for fixing this flawed payment structure.

One bright spot in the final rule was CMS’s decision to remove eight of the 10 proposed unnecessary or duplicative measures in its Outpatient Quality Reporting Program. As noted in its comment letter, WHA continues to be encouraged by CMS’s commitment to reduce these unnecessary burdens on hospitals’ quality reporting programs. WHA is continuing to look over this rule and will provide additional analysis in a future member communication.

Visit WHA’s OPPS webpage for more information.

This story originally appeared in the November 06, 2018 edition of WHA Newsletter