The Centers for Medicare & Medicaid Services (CMS) issued the final payment rates, rules and policies for physicians, home health care, hospital outpatient and ambulatory surgical centers in November 2013.
2014 Home Health Payment Rule
The changes for 2014 are intended to promote lower costs for taxpayers and beneficiaries. Under the Home Health Prospective Payment System (HH PPS), the final rule reduces Medicare payments by 1.05 percent. “This amount reflects the combined effects of an increase in the home health payment update percentage of 2.3 percent, offset by a decrease of 2.7 percent—the result of rebasing the adjustments required by the Affordable Care Act—and a 0.6 percent decrease due to a refinement of the HH PPS Grouper,” says CMS.
The Affordable Care Act requires CMS to begin rebate adjustments according to the national, standardized 60-day episode payment rate and other relevant factors. The final rule also adds two new quality measures. Home health agencies will be required to report preventable trips to the emergency department and unnecessary hospital readmission rates.
2014 Outpatient and Ambulatory Surgical Center Policy and Payment Changes
The new rule provides hospitals and ambulatory surgical centers the flexibility to lower outpatient facility (per-case) costs and increase the long-term financial stability of Medicare. These provisions, outlined in the Hospital Outpatient Prospective Payment System (OPPS), will allow a single code for patients, ultimately assisting in payment for multiple services. “These changes are essential if we’re going to create a health care system that delivers better care at lower cost. The final OPPS/ASC rule gives hospitals a stake in managing their resources to generate better coordinated and ultimately, more affordable outpatient care,” said CMS Principal Deputy Administrator Jon Blum.
The final rule increases hospital outpatient department payments by 1.7 percent and ambulatory surgical centers by 1.2 percent. Medicare payments to ambulatory surgical centers is expected to be $143 million. Data will be collected in 2014 and the proposed rule, including three new quality measures, will impact payment beginning in 2016.
2014 Physician Payment Rates
The payment rates and policies in 2014 for physicians is focused on improving care coordination and supporting care outside of office interactions. The rule announces a 20.1% reduction in Medicare payment rates for physicians and non-physician practitioners, as well as sets a cap amount on outpatient services at $1,920. The rule also makes changes to payments to critical access hospitals starting January 1, 2014. Major changes to the Physician Quality Reporting System (PQRS) will be seen in 2014. For example, physicians and healthcare providers can avoid the PQRS penalty of 2.0 percent by reporting at least 3 individual measures through claims or register 50% or more eligible Medicare patients during the reporting period. Additionally, providers will be required to report nine quality measures (vs. three previously) to qualify for the 0.5 percent bonus payment in 2014.
The estimated Medicare payments to physicians in 2014 are projected at $87 million.
Full details on the final policies for the 2014 calendar year can be found at
www.cms.gov/newsroom.