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Legislation would allow for higher outpatient, off-campus payment rates

The bill closes a loophole in the 2015 Budget Act related to Medicare payments for off-campus hospital outpatient departments.

Susan Morse, Associate Editor

Bipartisan legislation introduced Wednesday by the leaders of the  House Ways and Means Subcommittee on Health resolves two provisions of the Bipartisan Budget Act of 2015 in allowing hospitals that are building outpatient facilities off-campus to be paid at higher  reimbursement rates, and in taking into consideration for payment,  socioeconomic status.

Health Subcommittee Chairman Pat Tiberi, R-Ohio, and Health Subcommittee Ranking Member Jim McDermott, D-Washington,  introduced the legislation, H.R. 5273, "The Helping Hospitals Improve Patient Care Act," to address payments to hospitals and other Medicare providers. 

The bill closes a loophole in the 2015 Budget Act related to Medicare payments for off-campus hospital outpatient departments. The law did not take into account facilities that were "mid-build" as of the date of the enactment in November 2015.

It also allows cancer hospitals to be continued to be paid at cancer hospital rates at new off-campus locations.

The legislation gives improved consideration of socioeconomic status in the Hospital Readmissions Reduction Program, that levies fines over excessive readmissions.

The provisions are offset by a slight reduction in the hospital inpatient documentation and coding adjustments as implemented in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, according to the legislation.

Also, they are offset by a slight reduction in the payments cancer hospitals currently receive as calculated by their payment to cost ratio.

The Helping Hospitals Improve Patient Care Act also includes a number of other provisions that have previously passed the Committee on Ways and Means, including a "mid-build" exception to the current law on increasing the number of beds for long-term care hospitals; modification of the treatment of ambulatory surgery center patient encounters for the meaningful use program; a delay in CMS authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings as CMS conducts research and reports on socioeconomic status and quality ratings; and a requirement that CMS report Medicare enrollment data by Congressional district.

The bill also includes an extension of the rural community hospital demonstration program and direction that CMS improve the notice provided to individuals upon Medicare eligibility.

In addition, the legislation requires a cross walk of ten inpatient surgical codes that will be linked to outpatient surgical codes.

The legislation is fully offset and paid. 

"The Helping Hospitals Improve Patient Care Act takes responsible steps to strengthen Medicare and give hospitals and healthcare providers the certainty they need to best serve their patients. It is fully paid for and includes many bipartisan provisions that are priorities to members of the Ways and Means Committee," said Subcommittee Chairman Tiberi.

"The Helping Hospitals Improve Patient Care Act makes important changes that will allow hospitals to continue to provide high-quality care to patients as we implement recent payment reforms," said Subcommittee Ranking Member McDermott.
The bill has received support from the Federation of American Hospitals and the Association of American Medical Colleges.

" … I am pleased to offer the support of the FAH for this targeted, thoughtful measure that would, among other provisions, allow community hospitals to finalize essential outpatient arrangements in order to better serve patients in their communities. At the same time, while the reduction might be viewed as minor, the effects of cumulative cuts on hospitals are taking a toll, and further cuts must be avoided," the FAH said in a statement.

The American Medical Colleges said, "The two provisions allow the consideration of socioeconomic status in the Medicare Hospital Readmissions Reduction Program and provide relief to 'mid-build' hospital outpatient departments."

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