Hospital outpatient facilities, ASCs will get 2.9% pay bump
By Alex Kacik / November 1, 2024
Hospital outpatient departments and ambulatory surgical centers will receive a 2.9% Medicare pay boost next year under a final rule the Centers for Medicare and Medicaid Services issued Friday.
The reimbursement increase is up from the 2.6% hike CMS proposed in July. The hospital outpatient payment update reflects a 3.4% hospital market basket increase offset by a -0.5% productivity adjustment.
Hospitals must also meet new quality standards for obstetrical care to qualify for Medicare reimbursement under the regulation. The updated conditions of participation include new staffing requirements, one of which involves supervision of obstetrical patients by a registered nurse, midwife or other practitioner with the necessary training. In addition, facilities are required to keep basic obstetrics equipment readily available, conduct one performance improvement project a year, be ready to provide emergency services and have written policies for transferring patients, among other provisions.
The American Hospital Association criticized the pay bump and certain elements of the new maternity care measures. CMS’ insufficient reimbursement increase and overly punitive approach to maternity care will jeopardize access, Ashley Thompson, senior vice president of public policy analysis and development at the AHA, said in a news release.
“While we appreciate that the final rule provides hospitals with additional implementation time and greater flexibility in how they meet certain requirements, we remain concerned about CMS’ excessive use of conditions of participation to drive its policy agenda and the potential risk for these requirements to inadvertently reduce access to maternal care,” she said in the release.
Under the final rule, CMS created a per diem pay method for psychiatric care delivered at hospital outpatient departments and community mental health centers. The Partial Hospitalization Program and Intensive Outpatient Program will designate two payment types: one for days with three services and another for days with at least four services. CMS will calculate reimbursement based on 2023 claims data and cost reports.
The rule also boosts payments for non-opioid pain relief next year, as required by Consolidated Appropriations Act of 2023.
The regulation also implements several new health equity measures for hospitals, rural emergency hospitals and ambulatory surgical centers. Some of those provisions include screening for social drivers of health, identifying high-needs populations and working with community organizations to reduce health disparities.