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CMS Finalizes CY 2015 OPPS and PFS Rules

The Centers for Medicare & Medicaid Services (CMS) released Oct. 31 the calendar year (CY) 2015 Outpatient Prospective Payment System (OPPS) and Physician Fee Schedule (PFS) final rules with comment periods. Finalized points of note include the following:

OPPS

  • 2.2 percent net fee schedule increase factor for CY 2015
  • Data collection will begin on services provided in off-campus, provider-based departments. Hospitals and physicians will be required to identify these services using a modifier on hospital and physician claims. Data collection will be voluntary for 2015 and required of all hospitals in 2016.
  • Comprehensive ambulatory payment classifications (APCs) for device-dependent services will be established, including the addition of two new comprehensive APCs.
  • Three measures will be removed from and one added to the Hospital Outpatient Quality Reporting Program.

PFS

CMS finalized a number of provisions regarding the Medicare Shared Savings Program (MSSP), which are of particular interest to members of America’s Essential Hospitals.

  • CMS will reward accountable care organizations (ACOs) that make year to year improvements in quality performance.
  • CMS modified how quality measures are deemed “topped out.” The agency will now use flat percentages to establish the benchmark for a measure when data results in the 90th percentile are greater or equal to 95 percent.
  • CMS modified the quality reporting measure set to reflect up-to-date clinical practice, reduce duplicative measures, focus on claims-based reporting, and try to reduce the reporting burden on ACO providers.
  • The total number of measures collected for the MSSP was not modified – it will remain 33 – but CMS increased the number of claims-based measures and decreased the number of measures reported by the ACO through the group practice reporting option web interface.

The provisions in both rules take effect Jan. 1, 2015. America’s Essential Hospitals will send a more detailed summary of the final rules to members in the coming days. Please contact Xiaoyi Huang, JD, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.