Boost for outpatient surgery
The agency is also phasing out its policy of paying for some procedures only if they’re done in inpatient settings. About 300 mostly musculoskeletal-related services will be cut first, followed by the rest of the inpatient-only list by 2024. CMS will continue to pay for those treatments in either inpatient or outpatient settings and encouraged providers to use their judgment on the most appropriate care venue.
Hospital groups and several experts had argued against ending the inpatientonly list, claiming the move could jeopardize quality and safety because many of the procedures are high risk. Hospitals also worried about how the move could affect their finances since it would likely lead to more treatment in lower-cost settings.
“Private payers already pay for these services and they don’t restrict the site of care,” Verma said, adding that it’s doctors’ responsibility to decide the best place for a patient to have surgery based on individual needs.
CMS also advanced changes that could increase provider competition, including allowing physician-owned hospitals to expand if they treat large numbers of Medicaid patients. Ambulatory surgical centers will be able to perform 11 more procedures, including total hip replacement.
The rule also extended the current payment policy of average sales price minus 22.5% for 340B-acquired drugs. CMS had floated further cuts in its proposed rule based on the results of an acquisition cost survey. Providers balked at the proposal, claiming that the survey was flawed and could threaten beneficiaries’ access to care in the midst of the pandemic.
“This rule would be bad policy at any time and is especially harmful now, as the public health emergency intensifies and front-line hospitals face unprecedented capacity and cost pressures. There is no policy justification for the agency’s damaging Part B drug payment cuts to hospitals in the 340B Drug Pricing Program,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals.
During a call with reporters, Verma said the agency would continue to evaluate whether more cuts are needed to protect taxpayers. She argued the 340B program can encourage provider consolidation and drive up healthcare costs. ●