WHA Comments on Proposed 340B and Site-Neutral Cuts, Changes to Hospital Quality Star Ratings in 2021 OPPS Rule

October 08, 2020

In its comment letter submitted to the Centers for Medicare and Medicaid Services (CMS) October 5, WHA expressed continued concerns about CMS’ proposed cuts to 340B hospitals and hospital outpatient departments (HOPDs) in the proposed CY 2021 Hospital Outpatient Prospective Payment rule. Among other comments, WHA also noted both appreciation and caution over proposed changes to the CMS hospital quality star ratings.
In the proposed rule, CMS proposes either keeping the current policy of paying most 340B hospitals the Average Sales Price (ASP) minus 22.5% or imposing an even lower rate of ASP minus 28.7%. WHA noted that, for the proposed cut, CMS relied on a survey hospitals responded to in the midst of the pandemic, making the survey information inadequate and incomplete.
Given that the 340B program was designed to help hospitals “stretch scarce federal resources,” and that the cuts are currently under appeal in the U.S. Court system, WHA urged CMS to abandon any level of cuts.
The proposed payment rule continues the policy of paying clinic visit services in grandfathered off-campus HOPDs at the physician fee schedule rate, which is 40% of the OPPS rate. Like the 340B program, WHA noted this issue is also under appeal in the courts and that hospitals should not have to shoulder these cuts during a pandemic that is severely stressing hospital resources. WHA also wrote that many of these HOPDs were previously physician clinic offices that were in jeopardy of closing due to poor patient mixes and low payment rates under the physician fee schedule. Forcing HOPDs to continue accepting these lower rates could jeopardize the ability to sustain access to care.
WHA also expressed both optimism and concern over proposals by CMS to overhaul the hospital quality star rating system. WHA has previously commented to CMS with concerns about the complexity of the star rating method, the unreliability of the results, and the inability of our members to use these ratings in a meaningful way. While it is encouraging that CMS has heard the feedback from WHA and others, WHA cautioned CMS against implementing these changes too quickly. WHA wrote that prior to refreshing proposed star ratings changes, CMS should ensure changes to methods have been finalized and a process is put in place to include an independent audit that ensures current and future changes are implemented correctly.
For more information, contact WHA Vice President of Federal and State relations Jon Hoelter.

This story originally appeared in the October 08, 2020 edition of WHA Newsletter