OPPS For 2008 May Change From CMS' Proposed Rule

On July 16, 2007, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule regarding changes to the Medicare Outpatient Prospective Payment System (OPPS) for calendar year 2008. This rule will be published in the Federal Register on August 2, 2007, and comments will be accepted until September 14, 2007.

CMS sets forth the proposed framework of the new Hospital Outpatient Quality Data Reporting Program (HOP QDRP). Pursuant to the Tax Relief and Health Care Act of 2006, CMS is required to implement a hospital outpatient quality reporting program that will provide CMS with data to measure the quality of care provided in hospital outpatient departments. CMS also is required, beginning in calendar year 2009, to penalize hospitals that fail to provide outpatient data with a 2.0 percentage point reduction to the hospitals' annual outpatient payment update. A similar reporting program for inpatient quality measures has been in existence since fiscal year 2005. CMS is proposing 10 outpatient quality measures that hospitals will be required to report in calendar year 2008. CMS also lists 30 additional outpatient quality measures, and seeks public comment on the mandatory reporting of these measures in future years.

CMS proposes to increase the size of many OPPS Ambulatory Payment Classification (APC) groups. For 2008, CMS proposes to package seven categories of supportive ancillary services into the primary diagnostic or treatment procedures with which they are performed. These seven categories are: guidance services; image processing services; intraoperative services; imaging supervision and interpretation services; diagnostic radiopharmaceuticals; contrast media; and observation services. A likely result of this change is that payments for the primary APCs would increase, but CMS would no longer...