CMS Finalizes CY 2019 Payment Rules / by AzHHA

Debbie Johnston, Senior Vice President of Policy Development

The Centers for Medicare & Medicaid Services (CMS) last week issued the final CY 2019 Outpatient Prospective Payment System (OPPS)/ambulatory surgery center (ASC) rule and the final CY 2019 physician fee schedule (PFS) rule. AzHHA members will receive a detailed analysis of the CY 2019 OPPS rule in the coming weeks, including a forecast of their hospital-specific impacts.

We are disappointed that CMS did not heed the concerns of hospitals regarding the expansion of Medicare’s “site-neutral” payment policies in both rules. Nor did the agency pull back on its proposal to reduce payment for 340-B acquired drugs in non-grandfathered off-campus provider-based departments to the average sale price minus 22.5 percent. These proposals ignore the crucial differences between hospital outpatient departments and other sites of care and will further strain safety-net hospitals that serve vulnerable communities.

We are very pleased, however, that CMS is finalizing its proposal in the CY 2019 PFS rule to ease regulatory burdens associated with the documentation of E/M visits and expanding Medicare coverage of telehealth and virtual care. We are also grateful that CMS modified its proposal to consolidate level 2 through 5 codes into a single blended rate. Instead, the agency will finalize a single blended rate for level 2, 3 and 4 office and outpatient visits, effective CY 2021. AzHHA will continue to urge CMS to ensure that physicians who treat a disproportionate share of higher-acuity patients are not financially penalized under this approach.