AHA Comments on CMS Outpatient PPS and Ambulatory Surgery Payment System Proposed Rule for CY 2024

September 8, 2023

The Honorable Chiquita Brooks-LaSure
Administrator
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, DC 20201

Re: CMS–1786–P: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Payment for Intensive Outpatient Services in Rural Health Clinics, Federally Qualified Health Centers, and Opioid Treatment Programs; Hospital Price Transparency; Changes to Community Mental Health Centers Conditions of Participation, Proposed Changes to the Inpatient Prospective Payment System Medicare Code Editor; Rural Emergency Hospital Conditions of Participation Technical Correction Proposed Rule (Vol. 88, No. 145), July 31, 2023.

Dear Administrator Brooks-LaSure:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2024.

For CY 2024, CMS proposes a market basket update of 3.0% less a productivity adjustment of 0.2 percentage points, resulting in a net update of 2.8%. The AHA has strong concerns about this inadequate update, especially when taken together with the underwhelming market basket increases from CY 2022 and 2023. It does not capture either the unprecedented inflationary environment or the other persistent financial headwinds hospitals and health systems are experiencing. It also fails to account for the fact that labor composition and costs have remained extraordinarily high and that as a result, the hospital field has continued to face sustained financial pressures and workforce shortages. Therefore, we urge CMS to examine ways to account for these increased costs to ensure that beneficiaries continue to have access to quality outpatient care. We also urge the agency to reduce the productivity cut for CY 2024 as such a cut does not align with hospital and health systems’ public health emergency (PHE) experiences related to actual losses in productivity during the COVID-19 pandemic.

In addition, CMS proposes several changes to the hospital price transparency requirements related to standardization of and changes to CMS’ monitoring and enforcement processes, and requests comment on how to better align the various price transparency policies going forward. The AHA looks forward to working with CMS to improve the hospital price transparency rule, especially as it relates to better aligning these requirements with the Transparency in Coverage and No Surprises Act requirements.

Finally, the AHA is pleased that CMS recognizes that a more reliable and resilient drug supply is needed so that hospitals can better care for their patients and communities. However, we have several concerns and questions about the agency’s proposed policy to make separate payments under the inpatient PPS, and potentially under the OPPS, for the additional costs that hospitals face in establishing and maintaining access to a buffer stock of domestically manufactured essential drugs. While the AHA strongly agrees that it is necessary to support practices that can curtail shortages, we also continue to believe that much more must be done in addressing these concerns.

We appreciate your consideration of these issues. Our detailed comments are attached.

Please contact me if you have questions or feel free to have a member of your team contact Roslyne Schulman, AHA’s director for policy, at rschulman@aha.org.

Sincerely,

/s/

Stacey Hughes
Executive Vice President

View the detailed comment letter below.