Hospitals lose challenge to 2020 site-neutral pay cuts

https://www.beckershospitalreview.com/finance/hospitals-lose-challenge-to-2020-site-neutral-pay-cuts.html?origin=CFOE&utm_source=CFOE&utm_medium=email

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A Washington, D.C., federal judge ruled Dec. 16 that the court cannot stop CMS from enacting site-neutral payments for off-campus providers in 2020.

In its final Outpatient Prospective Payment System rule for 2019, CMS made payments for clinic visits site-neutral by reducing the payment rate for evaluation and management services provided at off-campus provider-based departments.

In an attempt to overturn the rule, the American Hospital Association and dozens of hospitals sued CMS, arguing it exceeded its authority when it finalized the cuts in the rule.  

U.S. District Judge Rosemary Collyer sided with the association and other hospitals in September, ruling CMS overstepped its authority when it expanded the site-neutral pay policy. But CMS moved forward with the site-neutral  cuts in its 2020 OPPS rule, slashing off-campus department payments to a rate of 40 percent of the OPPS rate.

The association asked Ms. Collyer to uphold her September decision in an attempt to stop the 2020 payment cuts from taking effect Jan. 1, but ruled Dec. 16 that the court doesn’t have jurisdiction to stop the continuation of the cuts next year.

“As a technical matter, the government correctly argues that the court’s previous order was limited only to the 2019 final rule,” the judge wrote.

The court loss for the association representing hospitals comes just days after CMS agreed to repay hospitals that were paid at the reduced rate this year.

“The AHA and other plaintiffs remain confident that the courts will find the 2020 cuts to be illegal, just as they found the 2019 cuts,” Melinda Hatton, the AHA’s general counsel, wrote in a statement to Becker’s Hospital Review.

Access the full ruling here.

 

 

 

 

Hospitals win back $800 million from Medicare

https://www.axios.com/hospitals-medicare-trump-administration-regulation-c7161fba-51b8-421b-b1d6-3e4615dd265c.html

Illustration of a statue of Justice wearing a doctor's coat and a stethoscope

The Trump administration is backtracking on a major policy that cut payments to hospitals while the policy is stuck in the courts.

The big picture: The hospital industry is getting back almost $800 million, and the Trump administration has failed to implement another regulation — one that most experts support, too.

Details: Any hospital that was paid a lower amount for a routine clinic visit in 2019 will automatically be paid the difference from the older, higher amount, the Centers for Medicare & Medicaid Services said in a bulletin on Thursday.

  • CMS wanted to create a level playing field, arguing that hospitals should not be paid more for these standard checkups when they could be done for far less in an independent doctor’s office.
  • Hospitals naturally hated the idea, took the government to court, won, and are now fighting to eliminate the policy from future years.

 

 

 

 

CMS retains 340B, site-neutral payment cuts in final hospital payment rule

https://www.fiercehealthcare.com/hospitals-health-systems/cms-retains-340b-site-neutral-payment-cuts-final-hospital-payment-rule?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiWTJZd1pqWXpZbVUwWTJKbSIsInQiOiJLV2JJQWM1clQ3OVBiaURjdFVUUUg2K093U21XZm0zVHNPa1hTUjdTWEdxSWZpYklsako0TVMrZFYxazVGZHFkOHJ3M1pWNlwvYW5pVWpPcjM1TEtVRnErOWgxU3NKc1dcLzk3TnZTc1pLZVI0Ymcrb0V1ZEZ2eDh1djFwa1FlaW50In0%3D

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The Trump administration finalized a hospital payment rule Friday that retains proposed cuts to off-campus clinics and the 340B drug discount program. 

The changes outlined in the hospital Outpatient Prospective Payment System (OPPS) rule come despite both cuts being struck down in legal challenges and amid major pushback from providers.

Site-neutral payments

The agency decided to move ahead with the two-year phase-in of the cuts to outpatient services for clinic visits furnished in an off-campus hospital outpatient setting. The goal is to bring payments to off-campus clinics in line with standalone physicians’ offices.

“With the completion of the two-year phase-in, the cost sharing will be reduced to $9, saving beneficiaries an average of $14 each time they visit an off-campus department for a clinic visit in [calendar year] 2020,” the Centers for Medicare & Medicaid Services (CMS) said in a fact sheet.

However, the two-year project that was supposed to start in 2019 has been halted because of a federal court ruling.

CMS decided to move forward with the cuts for off-campus clinics.

“The government has appeal rights, and is still evaluating the rulings and considering, at the time of this writing, whether to appeal the final judgment,” the agency said.

The American Hospital Association (AHA) said that the site-neutral payment rule was misguided and that CMS ignored the recent court ruling. 

“There are many real and crucial differences between hospital outpatient departments and the patient populations they serve and other sites of care,” said Tom Nickels, executive vice president of the AHA, in a statement.

CMS also finalized a proposed cut for the 340B program that cuts payments by 22.5% in 2020.

CMS has installed prior cuts in 2018 and 2019 to the program that requires drug companies to provide discounts to safety-net hospitals in exchange for getting their products covered on Medicaid.

However, a court ruling has struck down the cuts, and CMS is currently appealing the decision.

CMS said that it hopes to conduct a 340B hospital survey to collect drug acquisition cost data for 2018 and 2019, and the survey will craft a remedy if the appeal doesn’t go their way.

“In the event the 340B hospital survey data are not used to devise a remedy, we intend to consider the public input to inform the steps we would take to propose a remedy for CYs 2018 and 2019 in the CY 2021 rulemaking,” the agency said.

Hospital groups commented that CMS should drop both the 340B and site-neutral cuts because of the legal challenges.

Several groups weren’t happy that the cuts were still there.

“The agency also prolongs confusion and uncertainty for hospitals by maintaining unlawful policies it has been told to abandon in clear judicial directives,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, in a statement Friday.

The hospital-backed group 340B Health added that CMS needs to stop this “unfunny version of ‘Groundhog Day’ and restore Medicare payments for 340B hospitals to their legal, statutory level.”