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CMS Releases Proposed OPPS, Physician Fee Rules

Cheryl Clark, for HealthLeaders Media, July 9, 2013

CMS proposes to package ancillary or adjunct services for payment, and would reduce by 2% payments to ambulatory surgical centers that fail to meet quality reporting program requirements.

Significant changes are proposed for the outpatient quality reporting program, to affect payments in 2016, but with data collection starting Jan. 1, 2014. These new measures include:

  • Influenza vaccination coverage among healthcare personnel
  • Complications within 30 days following cataract surgery that require additional surgical procedures
  • An appropriate follow-up interval for normal colonoscopy in average-risk patients
  • A colonoscopy interval for patients with a history of adenomatous polyps to avoid inappropriate use.
  • Whether a cataract surgery patient's visual function improved within 90 days.

The proposed rule also contains more information that affects the agency's value-based purchasing program, defined under the Hospital Inpatient Prospective Payment Rule, for FY 2016. Specifically, the rule proposes to set baseline and performance periods for hospital rates of catheter-associated urinary tract infections, central line-associated bloodstream infections, and surgical site infections.

CMS proposes to change eligibility criteria for Quality Improvement Organizations, as well as the contracting process for those groups.

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