4027: July 27, 2010
Medicare Calendar Year 2011 OPPS Proposed Rule
On July 2, 2010, the Centers for Medicare and Medicaid Services published a display copy of the 2011 proposed rule for the Medicare Outpatient Prospective Payment System (OPPS). The proposal updates OPPS payments to reflect changes to the market basket, the wage index, the Ambulatory Payment Classification (APC) weights, and proposes other relevant rules.
This analysis by the Washington State Hospital Association’s Health Information Program looks at the impact of these proposed changes on Washington State hospitals and systems. Where possible, we also incorporate changes to OPPS payments mandated by the federal health reform legislation.
Unlike most Medicare payment programs, OPPS changes are effective on a calendar year basis, in other words, they will begin on January 1, 2011. The attached analysis prepared by the Health Information Program provides an estimate of the year-over-year impact of the major payment provisions of the proposed rule for your hospital. The analysis uses the data provided publicly by CMS in its impact file, and volume is held constant in order to highlight only changes due to payment policy.
We project an average 2.2 percent increase in total payments for Washington hospitals. It is important, however, that you review the impact on your facility. Individual hospital total impacts range from a loss of 0.4 percent to a gain of 4.1 percent.
The rule’s most significant proposals are:
- a 2.15 percent market basket increase reflecting a 2.4 percent update minus the 0.25 percentage point reduction mandated in the Patient Protection and Affordable Care Act;
- an outlier fixed-dollar threshold decrease to $2,025;
- updated wage index values;
- expiration of Section 508 wage index reclassifications on September 30, 2010 and hold-harmless transitional outpatient payments to rural and sole community hospitals with fewer than 100 beds on December 31, 2010;
- an addition of six new quality measures;
- revised policies for physician supervision of outpatient services; and
- completion of the ambulatory surgery center transition to OPPS-based payments (not included in this analysis as the underlying data are not available).
Attached is an Excel workbook containing the impact and payment for your facility, as well as the impact and payment for Washington State, and the nation. For much more detail, two other documents are linked:
1. A report description providing the assumptions and rules used in building the analysis; and
2. A summary of the proposed rule containing the actual language of the rule and instructions for submitting comments.
If you need assistance in using these documents or have other questions, please contact me at jimc@wsha.org or (206) 216-2551.