CMS has released the CY 2022 Hospital Outpatient and Ambulatory Surgical Center Payment Systems proposed rule with some intriguing proposals.

Key Headlines

• Hospitals and ASCs may see a 2.3% increase in payment for 2022
• Hospitals may see increased penalties if they do not provide charge information that patients can easily access
• Ambulatory surgical centers may be able to provide fewer services in 2022 as CMS looks to roll back policies designed to eliminate the Inpatient Only List
• Suggested updates to quality reporting programs
• Requests for comments on improving health equity and transitioning to the use of digital quality measures and FHIR HL7 standards for reporting
• CMS is seeking information on their plan to be reporting digital quality measurements using FHIR by 2025

Summary of Proposed Rule

Payment Updates

For 2022 rate setting, CMS is proposing to use 2019 claims and cost data because similar data for 2020, affected by the COVID-19, may not accurately reflect costs.

For CY 2022, CMS proposes to increase rates by 2.3% (this includes the 0.2% productivity adjustment that is removed from the market basket update of 2.5%).  This update is an estimated increase of $10.757 billion from CY 2021.  Ambulatory surgical centers (ASCs) will follow the hospital updates, resulting in a decrease in payment of approximately $20 million to these centers.  Hospitals and ASCs that do not meet quality reporting requirements will be subject to a 2% reduction in payment.

Payment for Hospital Outpatient Visits and Critical Care Services

CMS is proposing to continue with the current clinic and emergency department outpatient visits payment policies. They are also continuing the use of the Physician Fee Schedule PFS-equivalent payment rate for the hospital outpatient clinic visit service for HCPCS code G0463* when it is used by excepted off-campus provider base departments. The PFS-equivalent payment for the for CY 2022 is 40% of the proposed OPPS payment. 

*HCPCS code G0463 Hospital outpatient clinic visit for assessment and management of a patient.

Inpatient Only (IPO) List and ASC Covered Procedures List (CPL)

In 2021, CMS removed 298 services from the IPO list which allowed services to be provided in ambulatory surgical centers (ASCs).  CMS is proposing to halt the elimination of services from the IPO list and place these services back on the IPO list for 2022.  They also propose to more closely review the services to determine if they should be eliminated in future rulemaking. 

In relation to the IPO list changes, CMS is also proposing to remove 258 of the 267 procedures that were added to the ASC CPL in 2021.  They are also considering reinstating the criteria required for adding procedures to the list.

Hospital Transparency

Hospitals are required to make their standard charges available to the public in two ways: 1) as a comprehensive machine-readable file; and 2) in a consumer-friendly format. 

In this proposed rule, CMS is looking to increase the penalties for non-compliance with hospital price transparency rules and prohibit barriers to accessing standard charge information.  The proposed monetary penalty is a maximum of $300/day for hospitals with less than 30 beds and for larger hospitals a maximum fine of $10/bed/day with a maximum daily dollar amount of $5500. These penalties are proposed to be effective 1/1/2022. 

CMS is considering adding state forensic hospitals to the list of exempted facilities which currently includes VA hospitals and Indian Health Program hospitals.

CMS also sets expectations for online price estimator tools.  The proposed rule provides clarification about what the tool should include and asks for comments on policies and best practices for online price estimator tools.

Quality Reporting Programs

The proposed rule includes plans for the transition to digital quality measures (dQMs) for quality reporting.  CMS has a goal to move to dQMs in all quality and value-based programs by 2025. They are considering the use of FHIR HL7 standards for eCQMs and dQMs to improve interoperability, reduce clinician burden and improve patient care.

Hospital Outpatient Quality Reporting (OQR) Program

• No changes to data submission deadlines are proposed for 2022.
• Proposing to remove two measures (OP-2 and OP-3) and replace them with an eCQM: ST-Segment Elevation Myocardial Infarction (STEMI).
• Proposing to adopt three new measures: COVID-19 Vaccination Coverage Among Healthcare Personnel measure beginning 2022; Breast Screening Recall Rates measure beginning 2022; STEMI eCQM as voluntary in 2023 and mandatory in 2024
• Proposing to require: OP-37a-e: OAS CAHPS** as voluntary in 2023 and mandatory in 2024
• Proposing to require: OP-31: Cataracts beginning in 2023
• Requesting information on future adoption of a THA/TKA outcomes measure*** and measures to address Health Equity
• RFI request across programs on potential areas that could assist in great er digital capture of data using the FHIR standard.

**OAS CAHPS: Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems.  OP-37a-e is a survey based measure.

** *Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA)

Ambulatory Surgical Center Quality Reporting (ASCQR)

• No proposed changes to measure submission, thresholds, collection periods and data processing
• Proposing to adopt one new measure: COVID-19 Vaccination Coverage Among Healthcare Personnel beginning 2022
• Return to requiring data for previously suspended measures: ACD-1: Patient Burn; ASC-2: Patient Fall; ASC-3: Wrong Site/Side/Patient/Procedure; ASC-4: All-Cause Hospital Transfer/Admission; ASC-11: Cataracts; ASC-15a-e: OAS CAHPS.
• Requesting information on future adoption of THA/TKA outcomes measures, measures to address Health Equity, and Pain Management measures.

Hospital Inpatient Quality Reporting (IQR) Program

Stakeholders are encouraged to comment on the inclusion of the Safe Use of Opioids – Concurrent Prescribing measure for CY 2022.  Prior commenters are concerned that requiring the reporting of the measure may alter prescribing practices which could lead to increased difficulty for patients seeking treatment for Opioid Use Disorders.

Rural Emergency Hospitals

Beginning 1/1/2023, Critical Access Hospitals and small rural hospitals that convert to an REH may receive payment for services.  CMS is using this proposed rule to establish payment policies and requests stakeholder feedback on safety guidelines, health equity policies, quality measurement, payment provisions and enrollment processes.

340B Program Drugs

CMS is proposing to maintain the payment rate of Average Sale Price (ASP) minus 22.5 percent for some payable drugs or biologicals acquired through the 340B program.  Rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals are exempted from the policy.

Non-Opioid Products for Section 6082 of the SUPPORT Act

CMS is proposing to provide separate or modified payment for non-opioid pain drugs that function as supplies in the ASC setting.  The proposal is that starting January 1, 2022, non-opioid pain management drugs that function as a surgical supply in the ASC setting would be eligible for separate payment when it is FDA approved and indicated for pain management or as an analgesic. 

Disclaimer:

The information contained in this article is a summary and intended for educational purposes only. Interpretation of final rules and any guidance should be reviewed with your legal and compliance teams for applicability to your practice or organization.

References and Resources:

2022 OPPS Proposed Rule Press Release

2022 OPPS Proposed Rule Fact Sheet

2022 OPPS Proposed Rule

CCMS-1753-P Proposed Rule