The Centers for Medicare & Medicaid Services recently made several proposals that could reduce access to care in the community, particularly for vulnerable patients. The agency, in its proposed rule for the 2019 outpatient prospective payment system, proposed reducing payment for visits in certain off-campus hospital-connected clinics to 40 percent of the OPPS rate, a drastic cut. CMS also resurrected a proposal that would penalize these clinics if they have expanded the services they offer to their communities – taking away their ability to meet the changing needs of their patients and communities.

We’ve urged CMS to withdraw these proposals for several reasons. And we have bipartisan support in Congress.

First, CMS’s proposals ignore the fact that hospital outpatient clinics and independent physician offices treat different types of patients and conditions. These hospital-connected clinics tend to treat patients who are sicker or whose needs are too complex for physician offices.  

A recent study backs that up. It found that, relative to patients seen in an IPO, Medicare patients, including cancer patients, seen in hospital outpatient clinics are more likely to be:

  • From lower-income areas
  • Under age 65
  • Burdened with more severe chronic conditions
  • Previously cared for in an emergency department, thereby having higher Medicare spending prior to receiving ambulatory care
  • Previously hospitalized
  • Eligible for both Medicare and Medicaid

Second, CMS’s proposal clearly ignores the intent of Congress. Section 603 of the Bipartisan Budget Act of 2015 requires that, with the exception of dedicated ED services, services furnished in off-campus hospital clinics that began billing under the OPPS on or after Nov. 2, 2015, or that cannot meet the 21st Century Cures Act's "mid-build" exception, will no longer be paid under the OPPS, but under another applicable Medicare payment system. Clinics that began billing before that date were clearly protected from this rate cut. CMS’s proposal ignores that fact. 

Forty-eight senators on both sides of the aisle recently sent CMS a letter noting just that. "Congress was clear in its intention to grandfather existing facilities, so that only new off-campus sites would have payments reduced,” they wrote. “…Therefore, we ask that CMS ensure these facilities be treated as Congress intended and protected from the proposed cuts.” 

A similar bipartisan letter, led by Reps. Peter Roskam (R-Ill.), chair of the Ways and Means Health Subcommittee, and Mike Thompson (D-Calif.), is accepting signatures through Oct. 10. Please contact your representative today and urge him or her to co-sign the House letter. See our latest alert for more details.

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