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Providers Push Back Against OPPS Price Transparency Proposal

Analysis  |  By Jack O'Brien  
   September 30, 2019

The American Hospital Association submitted a 66-page comment to the proposed OPPS changes for 2020.

Provider organizations had plenty to say as the comment submission period for proposed changes to the hospital outpatient prospective payment system (OPPS) wrapped up late last week.

The proposal, first unveiled by the Center for Medicare & Medicaid Services (CMS) in late July, included a requirement for hospitals to make the negotiated charges with health plans public. Additionally, the proposal included a reduction to the federal reimbursement rate for hospitals that purchase prescription drugs under the 340B Drug Pricing Program at the average sales price minus 22.5%.  

The proposed rule had garnered 1,041 public comments as of Friday's deadline, most notably from hundreds of physicians and provider organizations, as well as associations representing providers.

The American Hospital Association (AHA) submitted a 66-page comment letter on Friday, detailing the organization's opposition to several aspects of the plan while calling it "the wrong approach."

The AHA said the proposal "should be abandoned" by CMS, arguing that several statutes exceed the agency's legal authority.

As a remedy, AHA is pushing CMS to reinstate "higher payment rates for clinic visits in grandfathered off-campus outpatient departments" and repay the difference to hospitals and health systems.

Related: Judge Grants Hospitals Victory in Site-Neutral Payments Dispute

For its part, the Association of American Medical Colleges (AAMC) urged CMS to reconsider several aspects of the proposed rule, including negotiated charges provision, the 340B drug pricing cuts, and the reimbursement cuts at excepted off-campus provider-based departments.

"[We] suggest CMS work with hospitals, insurers, consumers, and other stakeholders to better identify how to make available information that patients need to better understand the costs they will incur for hospital care," AAMC stated in its comment letter.

Related: Hospitals Sue HHS Over Site-Neutral Outpatient Payments

After the proposed rule was released over the summer, America's Essential Hospitals took aim at CMS over the continued cuts to the 340B program, calling them "unacceptable."

"CMS further puts care at risk for vulnerable people by maintaining its flawed policy of extending outpatient payment cuts to previously excepted clinics," Bruce Siegel, MD, MPH, said in a statement. "These cuts fall hardest on hospitals that care for low-income patients and create barriers to expanding access to care in underserved communities."

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

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