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Hospital Outpatient Issues
ACCC is committed to ensuring that cancer patients have access to the entire continuum of quality cancer care, including access to the most appropriate cancer therapies. Policy changes resulting from the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) continue to impact delivery of services provided in hospital outpatient departments. ACCC remains concerned that Medicare's payment policies will present obstacles to patient access to critical cancer therapies.
ACCC Submits Comments to CMS on 2011 Proposed HOPPS Rule
ACCC Efforts Pay Off: Drug Reimbursement in Hospital Outpatient Departments Set to Increase in 2011
ACCC members can view a detailed summary of the proposed 2011 HOPPS rule. After you log on to the Members-Only section, select MEMBER CONTENT.
The proposed 2011 Hospital Outpatient Prospective Payment System rule has been put on public display by the Centers for Medicare & Medicaid Services (CMS). In the 2011 proposed rule, CMS announced that reimbursement for drugs and pharmacy services will increase to ASP+6 percent from the current level of ASP+4 percent. ACCC has advocated for this change for the past three years, ever since reimbursement began to decrease in 2007.
In meetings with CMS staff and in testimony before the APC Panel, ACCC has stated that hospitals should be reimbursed at least ASP+6 percent, if not higher, for drugs and their associated pharmacy costs. ACCC data have shown that pharmacy overhead costs are higher than CMS allows for, and, therefore, the ASP+ number should be higher. Each year, CMS listened, but continued to decrease the reimbursement. ACCC continued to push for its position, and it appears that all of that effort has finally paid off.
While ACCC does not agree with every aspect of the proposed rule and will be submitting comments to CMS about those issues, ACCC is pleased that CMS has finally recognized our efforts and our data.
The comment period for this rule closes on August 31. ACCC will submit comments during that period. We anticipate the final rule by Nov. 1, 2010.
Click here to read payment allowance limits for Medicare Part B drugs effective July 1.
Physician Supervision. CMS also said it is implementing a number of significant payment provisions, including physician supervision requirements. In particular, CMS said it will allow certain nonphysician practitioners—specifically physician assistants, nurse practitioners, clinical nurse specialists, certified nurse-midwives, and licensed clinical social workers—to provide direct supervision for all hospital outpatient therapeutic services that they are authorized to personally perform according to their state scope of practice rules and hospital-granted privileges. Under current policy, only physicians may provide the direct supervision of these services.
The agency also said it will require that all hospital outpatient diagnostic services furnished directly or under arrangement, whether provided in the hospital, in a provider-based department, or at a nonhospital location, follow the Medicare physician fee schedule's physician supervision requirements for individual tests.
Other payment changes listed by the agency address drugs and pharmacy overhead, pass-through implantable biologicals, partial hospitalization services, kidney disease education, pulmonary and cardiac rehabilitation, therapeutic radiopharmaceuticals, and brachytherapy sources.
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