Medicare is making good on a promise to reduce what it sees as runaway costs for certain imaging services in its final rule on hospital outpatient payments for 2009.
The Centers for Medicare and Medicaid Services (CMS) also said that it will continue to hold outpatient departments accountable for quality of care by reducing payment when there has been a failure to meet reporting requirements.
The rule also covers ambulatory surgery centers (ASCs), and contains a separate set of requirements for those facilities.
In July, the CMS had proposed to increase outpatient pay by 3% in 2009; that has been increased to 3.6% in the final rule. Hospitals (and other entities that receive payments under the outpatient system) that do not report on the 11 quality measures required for 2009 will see their payments reduced by 2% in 2010, for an update of 1.6%.
Quality is a big centerpiece of the new rule. The CMS put hospital outpatient departments on notice that, in the near future, it expects to propose the withholding of payment for care related to illnesses or injuries acquired during the outpatient encounter. Hospitals are already being held accountable for acquired conditions on the inpatient side.
The final rule, published in the Nov. 18 Federal Register, applies to 4,000 outpatient departments, according to the CMS. The agency expects to pay $30 billion in 2009 for outpatient services, up from an estimated $28 billion this year.
As proposed earlier in the year, the CMS said that it will now make only a single payment for multiple images made in a single outpatient session.
The agency created five imaging-payment groups: ultrasound; computed tomography and computed tomographic angiography without contrast; CT and CTA with contrast; magnetic resonance imaging and magnetic resonance angiography without contrast; and MRI and MRA with contrast.
Most device-related procedures in cardiology, neurology, and gynecology will receive minimal increases in payment.
The agency also followed through on its proposal to institute four new payment groups for visits to “Type B” emergency departments (defined as those that are not open around the clock). Type B reimbursement will be lower than reimbursement for full-service emergency departments.