Statement on Proposed CY 2019 Outpatient OPPS Rule

Tom Nickels
Executive Vice President
American Hospital Association

July 25, 2018

With today’s proposed rule, CMS has once again showed a lack of understanding about the reality in which hospitals and health systems operate daily to serve the needs of their communities. CMS has misconstrued Congressional intent with its proposal to cut payments for hospital clinic services in certain outpatients departments. In 2015, Congress clearly intended to provide current off-campus hospital clinics with the existing outpatient payment rate in recognition of the critical role they play in their communities. But CMS’s proposal runs counter to this and will instead impede access to care for the most vulnerable patients.

While the agency inappropriately characterizes these clinic visits as “check-ups,” the reality is that hospitals serve some of the sickest, most medically complex patients in our clinics, evaluating them for everything from metastatic breast cancer to heart failure. CMS also has resurrected a proposal, which it had previously deemed unwise, that would penalize hospital outpatient departments that expand the types of critical services they offer to their communities – preventing them from caring for the changing needs of their patients. We will urge the agency to revise these punitive policies so that hospitals can continue to provide the highest quality health care.

CMS also stepped up its assault on 340B hospitals that serve vulnerable communities by expanding last year’s nearly 30 percent cut to outpatient drug payments to a significant number of additional hospital outpatient departments and life-saving drugs. These, like the previous cuts to a program that requires no federal contributions but instead relies on discounts required of drug companies, exceed CMS’s statutory authority and remain subject to legal challenge.

The cumulative action of these policies appear to result in close to $1 billion in unwarranted cuts to hospitals.

Contact:        

Marie Johnson, (202) 626-2351

Gabriella Valentine, (202) 626-2264

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About the AHA

The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the health improvement of their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks, other providers of care and 43,000 individual members. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at www.aha.org.