AHA, AAMC File Lawsuit Over Outpatient Payment Policy That Threatens Patient Access to Care

WASHINGTON, DC (December 4, 2018) – Today, the American Hospital Association (AHA) and the Association of American Medical Colleges (AAMC) filed a lawsuit against the U.S. Department of Health and Human Services (HHS) over an ill-advised and unlawful payment reduction to the outpatient prospective payment system (OPPS) that threatens access to care and hospitals’ and health systems’ ability to continue to meet the needs of their patients, especially those with the most complex needs and those in vulnerable communities.

At issue is a dramatic policy shift in the recent Centers for Medicare & Medicaid Services’ (CMS) OPPS final rule that reduced payments for off-campus hospital outpatient clinic visits. Today’s lawsuit argues that CMS is acting outside the law to make this harmful policy change.

The associations are joined in the suit by hospital plaintiffs: Olympic Medical Center in Port Angeles, Wash., Mercy Health in Muskegon, Mich., and York Hospital in York, Maine. The lawsuit was filed in the U.S. District Court for the District of Columbia.

“These cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the real and crucial differences between them and other sites of care,” said Rick Pollack, president and CEO of the AHA. “For example, patients who receive care in a hospital outpatient department are more likely to be poorer and have more severe chronic conditions than patients treated in an independent physician office. In addition, only hospitals provide 24/7 access to care for patients, regardless of their ability to pay, hospitals are held to far higher regulatory requirements, and hospital outpatient departments in inner cities and rural areas are often the only sites of care that provide the services they do.”

“It is alarming that CMS continues to propose cuts that will harm the teaching hospitals that provide care to the most vulnerable patients, including Medicare beneficiaries. Patients who seek care at teaching hospital off-campus outpatient departments often can only find care at these institutions,” said Darrell G. Kirch, president and CEO of the AAMC. “Successfully managing the complex medical needs of these patients requires considerable resources and coordination, and hospital outpatient departments are best positioned to provide that level of care.”
 

For additional information, a copy of the complaint can be found HERE.

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Media Contacts:

Colin Milligan
AHA Media Relations Office

(202) 638-5491

cmilligan@aha.org

Stuart Heiser

AAMC

(202) 828-0059

sheiser@aamc.org