CMS Proposes Updates for OPPS, Pitches Price Transparency Rules

July 29, 2019 - CMS has released three new proposed payment programs that aim to reduce administrative burden, put patients over paperwork, and increase price transparency for patients, the agency said in a statement emailed to journalists.

Specifically, CMS has proposed the 2020 Medicare Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule; the 2020 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Proposed Rule; and 2020 Medicare End Stage Renal Disease (ESRD) and Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Proposed Rule.

CMS has updated the OPPS and ASC payment system proposals to reflect a greater emphasis on price transparency and patient-centered care. The proposals specifically call on healthcare organizations to publicly report all of their pricing information.

“President Trump has laid out a clear vision for healthcare: a patient-centered system that puts you in control and provides the affordability you need, the options and control you want, and the quality you deserve. Providing patients with clear, accessible information about the price of their care is a vital piece of delivering on that vision, and it’s what the President’s executive order on transparency called for earlier this year,” said HHS Secretary Alex Azar said in a statement.

“Under this proposal, hospitals will finally have to make their real, negotiated prices known to patients, enabling patients to shop among providers. Healthcare leaders across the political spectrum have been talking about the need for real transparency for years. This proposal is now the most significant step any President has ever taken to deliver transparency and put patients in control of their care.”

Hospitals must also make payer-specific charges available for all shoppable services, meaning for services that a patient can schedule in advance, such as an outpatient visit or surgery. This will allow patients to understand the costs of their healthcare in the context of their health plan benefits.

CMS has also outlined a new proposal for the Physician Fee Schedule, aiming to cut down on the administrative burden for doctors.

“Clinicians are drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations,” said CMS Administrator Seema Verma. “These administrative costs add to the total cost of delivering healthcare, which means physicians often have to hire extra staff and spend more time complying with requirements instead of with their patients.”

The proposed changes would also increase the amount a physician is paid for more complex patients.

“Today one in five Medicare beneficiaries have multiple chronic diseases,” Verma explained. “We are announcing proposals so that the government doesn’t stand in the way of patient care, by giving clinicians the support they need to spend valuable time coordinating the care of these patients to ensure their diseases are well-managed and their quality of life is preserved.”

Finally, the agency has proposed updates to the ERSD prospective payment system (PPS) that would increase the payments CMS issued for certain therapies and technologies used for treating kidney disease, depending on the type of new therapy. CMS intends these payment increases to spur innovation in ERSD treatment.

“The changes we are proposing in this rule will also modernize outdated government policies to facilitate greater competition in the DME market, ensure accurate Medicare payments to protect taxpayers and advance innovation across our healthcare system so patients can receive the treatment options that work best for them,” Verma explained.