The Centers for Medicare & Medicaid Services (CMS) has announced plans to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments (HOPDs) and the payments hospitals receive for those services. In a final rule establishing Medicare payment and policy changes for services in HOPDs and ambulatory surgical centers (ASCs) for calendar year (CY) 2009, CMS reiterates its commitment to implementing Value Based Purchasing (VBP) initiatives across the continuum of beneficiaries' care and transforming Medicare from a passive payer to a prudent purchaser of health care.

The final Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) rule also includes a 3.6 percent annual inflation update for HOPDs; and adopts changes to payment policies for HOPDs and Ambulatory Surgical Centers (ASCs) beginning on January 1, 2009. The law sets the ASC update for CY 2009 at 0 percent.

"The direct impact of the new quality initiatives will be felt by the beneficiaries Medicare serves, and, as the nation's largest payer for health care services, we are pointing the way to better, safer, and more efficient care for all patients," said CMS Acting Administrator Kerry Weems. "In this final rule, we are continuing to pay appropriately for care while working with health care providers as we look for ways to make sure beneficiaries who come in for treatment of one complaint don't leave with two as a result of adverse events during their outpatient visits."
The final rule emphasizes that an urgent and compelling rationale exists for CMS to exercise its existing administrative authority under the Medicare statute to develop and implement a policy that would not pay hospitals for care related to illness or injuries acquired by the patient during a hospital outpatient encounter. Such a policy, which we expect to propose in the future, would be known as hospital outpatient healthcare-associated conditions (HOP-HACs), and it would make adjustments to OPPS payments to ensure equitable and appropriate payment for care, similar to the quality adjustments applied to payment for hospital-acquired conditions in the inpatient setting.

The rule also establishes new conditions of coverage (CfCs) for ASCs that reflect current ASC practice by focusing on the care provided to patients and the impact of that care on patient outcomes. These will help ensure ASCs are safely equipped and qualified to perform a much broader range of services under the revised ASC payment system, which was implemented on January 1, 2008 and will be in its second year of a four-year transition in the coming year. The new ASC CfCs will help improve assurance of the quality and safety of the care patients receive in ASCs.

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