Policy & Regulation News

Hospitals Say OPPS Proposed Rule Will Harm Patient Access to Care

The proposed OPPS rule would cut funding to hospital outpatient clinics, which in turn will hinder patient access to care, hospital groups say.

opps patient access to care

Source: Thinkstock

By Sara Heath

- Hospital associations across the country are speaking out against the recent CMS proposed Hospital Outpatient Prospective Payment System (OPPS) rule, stating that the rule will hinder patient access to care and increase out-of-pocket patient costs.

The proposed rule included site-neutral payments, meaning hospital and physician clinics will receive equal payments for Medicare. CMS intends this change to encourage patients to receive care where they choose without the potential for high out-of-pocket co-pays.

Hospitals say these cuts will seriously hinder their revenue flow and eventually harm patient care access.

The proposed cuts to hospital clinics goes against Congressional intent when current policies first did away with payment parity, the American Hospital Association’s executive vice president Tom Nickels wrote in a statement lambasting the proposal.

“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,” Nickels said.

READ MORE: CMS Proposed Rule to Let Patients Access Care at Preferred Sites

“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.”

Hospital clinics are the primary site for all types of care – even “check ups” – for some of the most vulnerable patient populations, Nickels explained. Cutting funding to hospital clinics will harm an important safety net for these populations, he said.

AHA also criticized proposed changes to the 340B program, stating that they go outside of the agency’s cope of authority. Proposed changes would limit the number of hospitals treating safety-net populations that can benefit from the 340B program.

“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,” Nickels asserted.

America’s Essential Hospitals likewise opposed the proposed cuts to both off-campus hospital provider-based departments (PBDs) and to the 340B program. Specifically, the organization said the CMS proposals would cut the legs out from under the safety net.

READ MORE: Verma: CMS Makes Strides in Patient-Centered Care, Medicare Reform

“Today’s proposed rule for Medicare outpatient payments would make bad policies worse, impose draconian new cuts that jeopardize health care access for millions of vulnerable Americans, and undermine the foundation of support for our nation’s health care safety net,” said Bruce Siegel, MD, MPH, president and CEO at America’s Essential Hospitals.

These proposals are not patient-centric, contrary to the arguments CMS has made in support of their proposals. In announcing the OPPS proposed rule, CMS stated creating site-neutral payments and adjusting the 340B program would empower patients with more choice in their healthcare and lowered out-of-pocket costs.

This is not the case, Siegel argued.

“The Centers for Medicare & Medicaid Services (CMS) frames its proposals as empowering patients and providing more affordable choices and options,” he said. “But we believe these proposals only would create road blocks to care in communities across the country — communities that already struggle with care shortages and severe economic and social challenges.”

The Association of American Medical Colleges added to the arguments, saying the OPPS proposed changes will hinder safety-net clinics that participate in the 304B program.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

“Inexplicably, the administration has decided to double-down on its flawed policy by extending harmful cuts to safety net hospitals, many of which are teaching hospitals, that participate in the 340B Drug Pricing Program,” said AAMC president and CEO Darrell G. Kirch, MD.

Cuts in payments could considerably hinder teaching hospitals’ abilities to educate as well as treat vulnerable patient populations, Kirch said.

To add insult to injury, Kirch added that these latest changes go against proposed bipartisan legislation that woud rescind the cuts CMS began imposing as part of the 2018 OPPS final rule. This proposed legislation, introduced by Representatives David McKinley (R-W. VA.) and Mike Thompson (D-Calif.) has nearly 200 cosponsors, Kirch said.

The Community Oncology Alliance, on the other hand, had a generally positive review of the OPPS rule. The OPPS rule brings to light the idea of site payment parity, an issue that few patients are aware of but that nonetheless impacts their care.

Specifically, COA said the program changes will result in lower healthcare costs for cancer patients.

“The Trump administration deserves a huge round of applause for these bold proposals. They demonstrate a real commitment to meaningfully fix many of the misguided policies that cast a shadow on our nation’s cancer care system,” COA president Jeff Vacirca, MD, FACP, said in a statement.

“As evidenced by CMS’s calculations, this policy is fantastic news for seniors on Medicare and taxpayers,” Vacirca, who is also CEO of NY Cancer Specialists, added. “They will benefit greatly from reduced out-of-pocket spending when dealing with cancer care and other illnesses.”

COA executive director Ted Okun mirrored those sentiments, saying that changes to the 340B program and implementing site-neutral payments will improve patient access to care by getting rid of cost barriers.
“President Trump, HHS Secretary Azar, Administrator Verma, and the staff at HHS deserve a resounding round of applause for these spot-on and extremely positive proposals,” Okun stated. “Expanding the scope of 340B reforms and extending site-neutral payment policies included in this rule are good for cancer patients, the Medicare program, and all Americans. They will help fulfill President Trump’s promises to reduce health care spending.”

The proposed rule will be open for public comment before CMS makes finalized changes. As more organizations respond to the proposal, it may be telling of where the agency takes its final amendments.


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