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

Area of Science:

• Health Policy
• Healthcare Reimbursement
• Quality Improvement Programs

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 refinements to payment rates and reporting requirements.

Purpose of the Study:

• To revise Medicare's OPPS and ASC payment systems for Calendar Year (CY) 2019.
• To update quality reporting programs, including the Hospital Outpatient Quality Reporting (OQR) and ASC Quality Reporting (ASCQR) Programs.
• To modify measures within the Hospital Inpatient Quality Reporting (IQR) and PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Programs.

Main Methods:

• Final rule with comment period issued by Medicare.
• Analysis of payment rates and factors for OPPS and ASC services.
• Review and revision of quality reporting measures and program requirements.

Main Results:

• Changes implemented to OPPS and ASC payment rates for CY 2019.
• Updates to requirements for the Hospital OQR and ASCQR Programs.
• Modification of HCAHPS Survey measure and retention of CAUTI and CLABSI Outcome Measures in the PCHQR Program.

Conclusions:

• The rule provides updated payment structures for hospital outpatient and ASC services.
• Quality reporting programs are refined to enhance healthcare quality measurement.
• Specific measure adjustments aim to improve data accuracy and relevance in quality reporting.