Last week, the Centers for Medicare & Medicaid Services (CMS) announced a final rule that restates its commitment to implementing Value Based Purchasing incentives, one of which is to improve the quality of care with Medicare in hospital outpatient departments (HOPDs). CMS hopes to give hospitals an incentive to improve care by tying quality of care to payments.
Kerry Weems, CMS acting administrator, said “In this final rule, we are continuing to pay appropriately for care while working with health care providers as we look for ways to make sure beneficiaries who come in for treatment of one complaint don’t leave with two as a result of adverse events during their outpatient visits.”
The final rule emphasizes that an urgent and compelling rationale exists for CMS to exercise its existing administrative authority under the Medicare statute to develop and implement a policy that would not pay hospitals for care related to illness or injuries acquired by the patient during a hospital outpatient encounter. Such a policy, which we expect to propose in the future, would be known as hospital outpatient healthcare-associated conditions (HOP-HACs), and it would make adjustments to OPPS payments to ensure equitable and appropriate payment for care, similar to the quality adjustments applied to payment for hospital-acquired conditions in the inpatient setting.
Hospitals are projected to receive $30.1 billion in CY 2009 for outpatient services to Medicare beneficiaries. The final rule changes will apply to outpatient services provided by over 4,000 HOPDs in several types of hospitals, including general acute care, community mental health centers, and children’s hospitals.
