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What is Fair Payment for Outpatient Care?

Rene Letourneau, for HealthLeaders Media, March 25, 2013

New technologies make it possible for much of the care that used to require a hospital stay to now be delivered in an outpatient setting, but what happens to the provider payment when the site of care shifts?

The Centers for Medicare & Medicaid Services' Advisory Panel on Hospital Outpatient Payment regularly tackles this important reimbursement question as it works to establish fair payment rates for outpatient care.

This group of up to 19 members from the provider community, all of whom are selected by the HHS Secretary or CMS Administrator, convenes several times per year to hear presentations from vendors, providers, and others seeking adjustments to outpatient payment rates. The panel then offers advice and recommendations to CMS regarding appropriate reimbursement levels for these services.

Kris Zimmer, senior vice president of finance at St. Louis-based SSM Health Care, a 4,000-bed health system covering four states, recently joined the panel for a four-year term. At SSM, Zimmer oversees system finance, financial planning, and capital management, among other duties.

I recently asked him why he wanted to join the panel and what he hopes to achieve in his new role.

"Overall, in my mind, the panel provides an important service. As we know, more and more healthcare in our country is being delivered in an outpatient setting and we see a rapidly accelerating pace of change in terms of the technology that is available to take care of patients in an outpatient setting," Zimmer said.

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1 comments on "What is Fair Payment for Outpatient Care?"


Daniel Ross (3/25/2013 at 1:58 PM)
The outpatient hospital, CMS negotiations result additionally impacts the fees being paid by commercial health plan sponsors. Typically, the dollars not paid by the public plans were cost-shifted on to the commercial payors. One wonders how this committee can impact the Medicare cuts imposed by PPACA?