Skip to main content

CMS' 2024 Proposed Outpatient Payment Increase Not Enough, Could 'Jeopardize' Care

Analysis  |  By Amanda Norris  
   July 19, 2023

CMS released its proposed payment update for outpatient services, but hospital groups are saying it's not enough to fight "persistent financial headwinds."

Hospitals may be seeing a 2.8% payment increase for outpatient services for calendar year 2024, according to CMS’ 2024 OPPS proposed rule, but hospital groups say it is not enough.

This increase would also include a proposed 3.0% market basket update, offset by a 0.2% cut for productivity. According to the rule, ambulatory surgical centers (ASC) would also see a 2.8% increase in payment rates next year under the proposed ASC rule that was released alongside the OPPS rule.

CMS also proposes to continue using the productivity-adjusted hospital market basket update to ASC payment system rates for another two years despite plans to shift away from the system as hospital procedures shift to ASC settings.

In a statement American Hospital Association (AHA) executive vice president Stacey Hughes shared the association’s displeasure with the payment update.

“The AHA is concerned that CMS is proposing an outpatient hospital payment update of only 2.8% in spite of persistent financial headwinds facing the hospital field. Most hospitals across the country continue to operate on negative or very thin margins that make providing care and investing in their workforce very challenging day to day,” Hughes said.

“Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized,” Hughes said.

CMS also proposes multiple provisions that would improve access to behavioral health services, including implementation of a statutorily required Medicare benefit for intensive outpatient programs and a new payment code for remote group psychotherapy.

The agency also proposes to:

  • Change certain quality reporting programs
  • Delay the in-person visit requirement for remote outpatient mental health services until the end of 2024
  • Finalize regulations establishing the rural emergency hospital provider type
  • Update the Medicare payment rates for partial hospitalization program services
  • Update the Conditions of Participation for Community Mental Health Centers

CMS will accept comments on the proposed rule through September 11.

Amanda Norris is the Director of Content for HealthLeaders.


KEY TAKEAWAYS

CMS released the 2024 OPPS proposed rule, affecting payment rates for outpatient services.

“Without a more robust payment update in the final rule, hospitals’ and health systems’ ability to continue caring for patients and providing essential services for their communities may be jeopardized.”


Get the latest on healthcare leadership in your inbox.