Today the Digestive Health Physicians Association (DHPA) filed comments in response to the Outpatient Prospective Payment System (OPPS) Proposed Rule for Calendar Year 2017 issued by the Centers for Medicare & Medicaid Services (CMS). DHPA’s comments focused on steps that CMS has proposed to implement the site neutrality provisions of the Bipartisan Budget Act of 2015 (BBA). Those provisions limit new hospital off-campus provider-based departments (PBDs) from billing at higher costs under the OPPS.
In its comments, DHPA supported CMS’s view that Congress intended “to curb the practice of hospital acquisition of physician practices that then result in receiving additional Medicare payment for similar services.” DHPA urged CMS to consider the wider trend of hospital acquisition of independent medical practices and ambulatory surgery centers in recent years, which has led to increased healthcare costs in many communities due to vertical consolidation. For example, prior to enactment of the BBA, when hospitals acquired Ambulatory Surgery Center (ASC), they could nearly double the amount charged to Medicare for colonoscopies as when the identical services were provided in free-standing ASCs.
DHPA also asked CMS to modify certain proposals to ensure that existing, vertically consolidated systems excepted from the site neutrality rules, may receive payment under the OPPS only if those systems actually furnish items and services, “as they were being furnished on the date of enactment.” DHPA wanted to ensure that loopholes do not get created – even unintentionally – that encourage the shift of care from the more cost-efficient independent practice setting to the higher-cost hospital setting. Accordingly, DHPA made the following requests:
- CMS should only allow excepted PBDs to bill under the OPPS for those items and services that the excepted PBD actually provided at some point during the twelve months prior to November 2, 2015. The Agency should not finalize its proposal to allow excepted PBDs to be paid under the OPPS for additional services that are in the same “clinical family,” but were not previously furnished at the PBD.
- CMS should finalize its proposal to require an excepted PBD to maintain its precise location as of November 2, 2015, as a condition of maintaining its “excepted” status. Any exception to this general rule should be extremely narrow and only apply in those circumstances when the Secretary has determined that a bona fide public health emergency exists.
- CMS should make permanent its “transitional policy” for 2017, which states that the non-facility rate under the Medicare Physician Fee Schedule should serve as the permanent standard for reimbursement of services provided by non-excepted, off-campus PBDs that were formally physician practices, just as the ASC fee schedule should remain the payment system that would apply to non-excepted, off-campus PBDs that were formerly independent ASCs.
This rule aligns well with DHPA’s mission to protect and promote the integrated and independent physician practice model. If implemented properly, the BBA and CMS’s corresponding regulations will serve as important first steps in ensuring that patients can continue to recieve high quality, cost-efficient care in the independent practice setting while minimizing the risk of that care being shifted into the higher-cost, hospital setting.
Click here to read the full comment letter.