What CMS’s 2022 OPPS Proposed Rule Means for Health Equity Efforts

July 21, 2021 - CMS aims to strengthen health equity efforts, improve patient safety, and expand access to care with its calendar year (CY) 2022 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule.

If finalized, the rule will touch on multiple facets of healthcare, from price transparency requirements to increased reimbursement rates for ASCs to a variety of health equity and patient safety efforts, as summarized below.

HEALTH DISPARITIES

To address health disparities, CMS pledged to improve data collection in the Hospital Outpatient Quality Reporting (OQR) Program to enable better health equity measurements. The agency suggested both the Within-Hospital Disparity Method and the Across-Hospital Disparity Method as means to improving health disparity reporting.

The Within-Hospital Disparity Method calculates differences in outcomes among various patient groups in a hospital while also factoring in clinical risk factors. The Across-Hospital Disparity Method will assess outcomes across multiple facilities for patients with a particular risk factor, allowing hospitals to better care for patients with certain social risk factors.

Both methods will enable hospitals to compare how successful they are at closing disparity gaps compared to other hospitals, CMS said.

READ MORE: What the 2022 Physician Fee Schedule Pitch Means for Health Equity

CMS is also seeking comments on its proposal to expand the collection, analysis, and reporting of data based on demographic variables and social risk factors. Variables include race and ethnicity, disability status, LGBTQ+, socioeconomic status, and Medicare and Medicaid dual eligibility status.

“CMS is committed to addressing significant and persistent inequities in health outcomes in the United States and today’s proposed rule helps us achieve that by improving data collection to better measure and analyze disparities across programs and policies,” CMS Administrator Chiquita Brooks-LaSure asserted in a public statement.

Diversity in data collection is increasingly important as many studies use CMS data to uncover revelations about disease prevention and management. Previous analysis suggests that medical research and even artificial intelligence algorithms often overlook minority populations and miss out on key data insights. More comprehensive data collection could combat this issue.

ACCESS TO CARE

In addition to a variety of health equity efforts, the rule emphasized the growing disparities that persist in rural communities due to the lack of access to care.

“Americans who live in rural areas of the nation make up about 20 percent of the United States population, and they often experience shorter life expectancy, higher all-cause mortality, higher rates of poverty, fewer local doctors, and greater distances to travel to see healthcare providers, than do their urban and suburban counterparts,” the rule stated.

A Government Accountability Office (GAO) report found that areas impacted by rural hospital closures saw median travel distance to the nearest hospital increase by approximately 20 miles between 2012 and 2018.

The Consolidated Appropriations Act of 2021 (CAA) established the Medicare designation of Rural Emergency Hospitals (REHs). The new proposed rule seeks feedback to help CMS develop equitable policies for the REH 2023 rulemaking period.

CMS is asking for comments and strategies regarding what services might be provided at REHs, from maternal health to opioid treatment programs and telehealth visits.

Rural health practices and providers were hit especially hard by the pandemic, and the gap between rural and urban death rates has tripled over the past 20 years. New guidance on REH policies and standards could provide much-needed assistance to struggling rural hospitals and underserved communities.

PATIENT SAFETY

The rule also took aim at reversing previous decisions that CMS said posed risks to Medicare beneficiaries. CMS wants to stop the phased elimination of the Inpatient Only (IPO) list that consisted of a number of services that Medicare would only cover if they were delivered in an inpatient setting.

CMS had previously agreed to eliminate this list with a phased approach but admitted in the rule that “This change happened without individually evaluating whether the procedures met the long-standing criteria previously used to determine if a procedure could be safely removed.”

CMS proposed adding back services like limb amputations and spinal procedures that were taken off the list in 2021, since these procedures cannot feasibly be done in an outpatient setting. In addition, the agency suggested reinstating the patient safety guidelines it uses to evaluate ASC procedures, which it removed earlier in the year.

“We are pleased that CMS recognizes the unique role that hospital outpatient departments serve in caring for patients, and that it proposes to roll back two problematic policies it advanced last year,” Stacey Hughes, executive vice president of the AHA, wrote in response to the proposed rule.

IMPROVING PATIENT EXPERIENCE AND HEALTH OUTCOMES

CMS also proposed changes to the Radiation Oncology (RO) Model which aim to improve patient experience and health outcomes. The RO Model “aims to improve the quality of care for cancer patients receiving radiotherapy and move toward a simplified and predictable payment system,” the press release stated.

CMS is proposing to begin RO Model implementation as soon as it is possible by law in January 2022 and end it in December 2026. The model will evaluate whether making site-neutral episode-based payments to hospital outpatient departments, physician group practices, and radiation therapy centers will improve the quality of care and patient experience while reducing Medicare spending.