Final OPPS Rule Increases Drug Payments

OPPS drug payment

Hospitals earned a big win with drug payments this year when CMS decided to finalize its proposal to follow the statute and reimburse facilities at the average sales price (ASP) plus 6%.

"We've been fighting for years to convince CMS to rely on the statute and provide payment for at least the acquisition cost of separately payable drugs at the level of ASP plus 6% and now the agency has finally agreed which is a nice win," Shah says.

Geometric mean

CMS finalized a change to the way it calculates APC relative weights. For 2013, CMS is using geometric mean costs instead of median costs to generate APC relative weights.

In the OPPS final rule, CMS did acknowledge some of the limitations of using the geometric mean but also addressed some of the benefits, including the agency's ability to make cost comparisons between IPPS and OPPS.

Commenters pointed out that the IPPS and OPPS payment systems differ in their rate-setting methodologies and that it will be hard for CMS to make accurate comparisons. The agency recognizes this but believes the positive aspects of moving to geometric mean outweigh the negatives and that meaningful comparisons are still possible.

The impact of moving to the geometric mean results in APC payment rate fluctuations that hospitals will need to review to determine how the changes will inpact their reimbursement.