Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality...

Area of Science:

• Health Policy
• Medical Economics

Background:

• Medicare's Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment system require regular updates.
• Experience with these systems necessitates ongoing adjustments to payment rates and quality reporting.

Purpose of the Study:

• To revise the Medicare hospital outpatient prospective payment system (OPPS) and ASC payment system for Calendar Year (CY) 2018.
• To implement changes based on operational experience and update payment rates and quality reporting requirements.

Main Methods:

• Analysis of current operational data and policy experience with OPPS and ASC payment systems.
• Development of revised payment rates and factors for Medicare services.
• Refinement of quality reporting program requirements.

Main Results:

• Updates to payment rates and factors for Medicare services under OPPS and ASC systems for CY 2018.
• Revised requirements for the Hospital Outpatient Quality Reporting (OQR) Program.
• Updated requirements for the ASC Quality Reporting (ASCQR) Program.

Conclusions:

• The final rule with comment period ensures Medicare payment systems remain current and effective.
• The revisions aim to improve payment accuracy and quality measurement in hospital outpatient and ASC settings.