Outpatient facilities will see financial losses because CMS has revised the list of inpatients only

The Centers for Medicare and Medicaid Services (Centers for Medicare and Medicaid Services) are retracting their efforts to pay for more complex services without hospitalization, a move that will weaken the revenues of health systems, which have increased their Investment in outpatient facilities.

The agency announced during the Trump administration that due to the complexity of the procedure, the patient’s underlying physical condition, or the need for at least 24 hours, it will phase out the list of approximately 1,700 services that medical insurance only pays during hospitalization. Recovery time after surgery. CMS will begin to phase out in 2021 by removing 298 services from the list.

But after a lot of lobbying by hospitals and medical associations on safety issues???????????????????????????????????????????????????????????????????? CMS has also removed most of the more than 260 procedures, which have been added to the list of procedures covered by separate outpatient surgery centers in the 2021 rules.

Delay, as in Final rules of the outpatient expected payment system It was released last week, which represents a significant change in the typical news of CMS. The agency has been proposing regulations to transfer care from high-cost inpatient treatment to outpatient surgery centers and other outpatient facilities.

CMS stated in the 2022 final rule that it realizes that the three-year time frame for phasing out the list is too short, and more time is needed to evaluate whether the services deleted in 2021 should really be deleted from the list.

“It seems to be a full 180 degrees,” said Susan Maupin, vice president of medical consulting firm Advis. “However, whenever a supplier expresses a security issue, CMS should take a step back and reassess whether there are any reasonable issues.”

Earlier efforts to move away from hospitalization have contributed to the health system to a certain extent Increase investment in outpatient facilitiesBut as CMS readjusts its methods, these new surgical centers may suffer financial losses.

Advis vice president Monica Hon said: “The business plans of those trying to establish ASC will be blown away for a while, but I don’t think this will be a permanent change.” The regulator took a step back.

Although the Association of Outpatient Surgery Centers Strongly opposed CMS removed most of the services added to the list of programs covered by ASC in 2021, and the organization agreed to the suspension announced by the agency. In its comments on the proposed rules, the group expressed concerns about a complete change in policy direction. Although ASC cannot always immediately execute procedures removed from the inpatient-only list, allowing services to be performed in the hospital outpatient department may be a precursor to its addition to the ASC list.

ASCA requires CMS to keep the three services performed in the ASC of other patient groups out of the inpatient-only list in 2022, and the agency agreed to do so in the final rule.

However, CMS also stated that 131 of the 298 services that were removed from the inpatient-only list in 2021 had one or no OPPS claim before May 21, 2021, indicating that the previous year’s policy did not affect clinical practice. Practice has too much impact.

“One of the obstacles is that if you discourage care in an outpatient setting, there is no incentive to make it a high-quality place,” said Dr. Sricharan Chalikonda, Chief Medical Operations Officer of Allegheny Health Network.

Allegheny Health is Keep its plan Transfer more procedures to its evolving network of outpatient surgery centers. Chalikonda said that in 2020, the number of operations for the 11 ASCs of the Pittsburgh Integrated Health System has increased by about 10%.

“Each market may not be ready to move to outpatient clinics, but we can only talk about what we are doing. In terms of how we design ASC, moving more things to the inpatient setting is a step back for us,” he Say. “If anything, I think the biggest impact on quality is quantity.”

Despite the CMS suspension, many health systems similar to Allegheny will not slow down investment in outpatient care. Industry observers say that regardless of medical insurance reimbursement, commercial insurance companies will still try to encourage care outside the hospital where appropriate.

Lynn Collins, senior manager of LBMC Consulting, said: “Many procedures will still be developed in the direction of outpatient clinics, especially orthopedic services.” It will be a challenge initially for ASC.”

Federal regulators target hospitals and hospital clinics Facility fee, They charge medical insurance for management fees and personnel costs for certain emergency departments.they have Fighting with the American Hospital Association in court A federal site neutrality policy that eliminates payment differences for evaluation and management services provided in hospital-owned outpatient departments and independent doctors’ offices.

Although moving more care out of hospitals will reduce medical costs, the warnings from hospitals and medical associations that quality will be affected seem to outweigh concerns about costs.

The Texas Hospital Association wrote in its comments to CMS that the abolition of the inpatient-only list would “bring undue safety risks to health insurance beneficiaries, impose administrative burdens on doctors and hospitals, and increase beneficiaries’ Financial burden and weaken the value of Part A insurance” last year.

Although the Dartmouth-Hitchcock Health Center generally supports the abolition of the inpatient-only list, it told CMS to remove the operation from the in-patient-only list, and to anaesthetize the same surgery on the list. People are confused.

The New Hampshire-based provider noted that the difference in payment between the inpatient DRG and the outpatient code may be at least $10,000. In addition, the agency wrote in its comments to the agency that a bundled payment plan that shifts from inpatient surgery to outpatient surgery will upset doctors who have honed their treatment options and may lose joint savings.

But industry observers say that apart from administrative ambiguities, the security argument doesn’t make much sense.this COVID-19 pandemic They emphasized that outpatient and home care can safely replace many inpatient procedures.

“I don’t understand the safety argument,” said Jeff Goldsmith, founder and president of Health Futures, a healthcare consulting company. “Utilization rate of inpatients is further declining, and people are trying to postpone the inevitable. As a patient, I don’t believe that outpatient care is not that safe.”

Allegheny Health has been improving its preoperative and postoperative care to shorten the length of hospital stay or avoid hospitalization altogether. Chalikonda said that the post-anaesthesia nursing room immediately began to recover, and clinicians regularly conduct virtual visits at home to check up with patients.

“We think this is the best for patients. If you build a good support system through virtual health and other resources, I think this is the future,” he said. “If COVID-19 has any results, we find that the transition from prolonged inpatient rehabilitation to outpatient care has not changed the quality.”

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