AHA urges CMS to protect access to care for hospital outpatients

The AHA Friday urged the Centers for Medicare & Medicaid Services (CMS) to protect patients’ access to care when it implements Sec. 603 of the 2015 Bipartisan Budget Act.

“The AHA is deeply disappointed that this law will result in substantial reductions to payments for services furnished in provider-based [hospital outpatient departments],” wrote AHA Executive Vice President Tom Nickels. “While we will continue to work with Congress to make changes to the provision to address the serious concerns of the field, we remain concerned that, as it stands, Sec. 603 will restrict patients’ care options. Therefore, we strongly believe that flexibility is needed when CMS implements this provision to protect patients’ access to care.”

P.L. 114-74, the Bipartisan Budget Act, creates site-neutral payments for new provider-based hospital outpatient departments – those that come into being after the Nov. 2 enactment of the legislation. Beginning Jan. 1, 2017, these departments would not be eligible for reimbursements under the outpatient prospective payment system, but would instead be eligible for reimbursements from either the ambulatory surgical center or physician payment systems.

In its Feb. 5 letter to CMS, the AHA said the agency should continue to consider all items and services provided in the same facility as a dedicated emergency department (DED) as part of that facility, and therefore excluded from the law’s site-neutral payment reductions, and that relocating, rebuilding or acquiring a grandfathered DED in the future should not trigger the law’s site-neutral payment reductions.

“To do otherwise would mean that hospitals’ outpatient services would essentially be frozen in place, with no ability to respond to environmental, financial or population pressures or demands – this is clearly unrealistic and impractical and not what the Congress intended,” the AHA said.