News: OPPS rule proposes 2.7% increase in payment rates

CMS released a proposal for the calendar year 2023 Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System on July 15, 2022, which includes updates to OPPS and ASC payment rates and Rural Emergency Hospital (REH) policies. The proposed policies will affect 3,411 hospitals and about 5,500 ASCs, according to the proposed rule fact sheet.

Notably, hospital OPPS rates would increase by a net 2.7% in 2023 compared to 2022 under the new rule. This is based on the projected hospital market basket percentage increase, reduced for productivity adjustment. Commenting on this payment update, American Hospital Association (AHA) Executive Vice President Stacey Hughes said, “We are deeply concerned about CMS’ proposed payment update of only 2.7%, given the extraordinary inflationary environment and continued labor and supply cost pressures hospitals and health systems face. [...] A much higher update is warranted, and we will be closely analyzing CMS' proposed market basket, as well as its proposed productivity offset.”

The proposal does intend to restore the Medicare outpatient payment to average sales price plus 6% for 2023, AHA News reported, in light of the Supreme Court’s recent decision in American Hospital Association v. Becerra. This would help hospitals that were affected by CMS’ OPPS cuts in recent years.

Regarding the REH model, the rule proposes to “consider all covered outpatient department services as REH services, to allow for a change of information application in order to convert to an REH, and to update the physician self-referral law for the REH, among other proposals,” AHA News said. Rural sole community hospitals would also be exempt from site-neutral clinic visit cuts, with payments for clinic visits in excepted off-campus provider-based departments instead at the full OPPS rate. CMS proposes updates to the physician self-referral law for the new REH provider type as well.

The proposed rule will have a 60-day comment period, after which the final rule will be issued in November.

Editor’s note: To read AHA News’ coverage of this story, click here. To read the CMS proposed rule fact sheet, click here.