House lawmakers urge CMS to provide positive outpatient PPS update to hospitals

A bipartisan group of 95 House lawmakers earlier this week urged the Centers for Medicare & Medicaid Services (CMS) to scuttle its proposed payment cut for hospital outpatient services and provide a positive update in its final outpatient prospective payment system (PPS) rule for 2016.

“Medicare already pays providers less than the cost of care,” the lawmakers wrote CMS. “Prescribing a negative update to [outpatient PPS] rates will only make it more difficult for hospitals to serve their patients and their communities, particularly as they move to adopt delivery system reforms.”  

Reps. Pat Tiberi, R-Ohio, and Richard Neal, D-Mass. led the House effort to persuade CMS to reject a 2016 cut in hospitals’ outpatient PPS rates.

In the proposed outpatient PPS rule released July 1, CMS called for a net decrease in outpatient PPS payments of 0.2%. The proposed cut largely results from a proposed 2 percentage point cut intended to account for CMS’s overestimation of the amount of packaged laboratory payments for laboratory tests that were previously paid under the Clinical Laboratory Fee Schedule.

The AHA sharply criticized the proposal in its Aug. 27 comments on the regulations. The association said the proposal is “founded on questionable assumptions, a poorly described methodology and data that are not publicly available.”

The House lawmakers shared the AHA’s concerns. “We urge you to use public data and maintain transparency in all policy making, but especially when reimbursements for providers could be cut so drastically,” the House letter stated.  

The lawmakers asked the agency to “reconsider its approach and provide better scrutiny and transparency to the data used to justify” the proposed cut. They urged CMS “to work with Congress to ensure all annual updates remain positive.”

CMS is expected to issue a final outpatient PPS rule by early November.