A Whopper of a Day with CMS

Its a whopper of a day if you're a hospital administrator. CMS is moving forward on a number of initiatives (and we believe it is all but certain to take effect 1/1/2019). So, here's quick rundown -- or you can read the 2,000+ page document by clicking the link at the bottom of this article -- you make the call:

* Outpatient Prospective Payment system will get a net 1.35% upward payment adjustment (good news) but a number of 'inpatient' only procedures are now off the list (opening up more competition for short-stay acute hospitals). In addition, the 'provider based billing' premium that hospital-based physicians have enjoyed is going 'bye-bye' with rates for hospital-based and 'normal' physician fee schedule set as 'equal'.

* ASC's will get a net 2.1% reimbursement increase and an additional 12 cardiology procedures available to ASC's that (plus the regulation eliminating a requirement for local hospital admitting privileges) assures heated competition between Hospital systems and their cardiology physician practices....and orthopedists...and...you get the picture.

* If hospitals were banking on continued margin from 340b pharmacy pricing and downstream sales, hold on to your wallet because the final rule on 340b sets pricing at ASP minus 22.5% (well below historical payment rates). And, we predict more reporting, transparency and limitations are coming down the pipe as well.

* ...and on a brighter note...payment prospects are not all gloom and doom... Cancer Hospitals (no appreciable change), Rural Sole Community Hospitals (+7.1% net increase) and a few other folks are no worse off and likely better off

Final Rule and Instructions for Comment