Highlights from the Medicare Hospital Outpatient Final Rule for 2010

Highlights of the Medicare Outpatient Hospital Payment Final rule for 2010

Hospital OPDs will get an average of 2.1 % annual inflation update from Medicare.  Expenditures are projected to be $32.2 billion in CY 2010. 

  • Payment:  APC Codes for Hospital ED visits show slight increase with two exceptions  (see attached table)
    • Type A ED facility payments increase by 2 percent
    • For 2010, CMS added a Level V Type B APC, which is $184 less than the Type A level V payment. (Last year, Level V Type B was paid at the same level as Type A)
    • CMS is reducing payment for trauma response with critical care.  (While the $101 is a significant reduction, payment from 08 to 09 increased by over $600.  CMS has more claims to review and adjusted median costs accordingly.)
  • Quality Reporting Measures:  OPPS payment inflation update is reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements starting from 2008. 
    • No new quality measures were proposed for 2010
    • Hospitals will continue to report data on seven quality measures of emergency department and peri-operative surgical care. 
    • CMS is considering an ED throughput measure for CY 2012 payment determination, "Median Time from ED Arrival to ED Departure for Discharged ED Patients." The measure specifications can be found at http://www.qualitynet.org/ in Appendix P of the specifications manual under Hospital –Outpatient.
    • CMS is establishing a process to make HOP quality measure data publicly available as early as June 2010
  • Health care Acquired Conditions:  As we requested, CMS did not propose any measures for 2010 acknowledging the complexity of implementation in the outpatient setting as well as lack of analysis of the current data from the inpatient hospital acquired conditions initiative started in 2008
  • Facility Coding for ED Visits: CMS is content to allow hospitals to use their own coding guidelines, again citing stability of claims distribution over the past several years.

Outpatient Payment for APCs of Interest to EM

APC

Group Title

    SI     

 Payment Rate 2008  

 Payment Rate 2009  

  Proposed Payment Rate 2010  

  Payment Change 2009 - 2010  

 % Payment Change 2009 - 2010

609

Level 1 Type A Emergency Visits

V

$50.76

$52.66

$53.65

$0.99

1.879

613

Level 2 Type A Emergency Visits

V

$83.67

$86.14

$88.35

$2.21

2.565

614

Level 3 Type A Emergency Visits

V

$132.17

$136.70

$140.27

$3.57

2.701

615

Level 4 Type A Emergency Visits

V

$212.59

$217.91

$225.29

$7.38

3.386

616

Level 5 Emergency Visits

V

$315.51

$323.90

$330.75

$6.85

2.114

617

Critical Care

S

$466.02

$485.39

$508.56

$23.17

4.773

618

Trauma Response with Critical Care

S

$330.28

$935.12

$802.90

($132.22)

-14.139

626

Level 1 Type B Emergency Visits

V

 

$45.18

$45.51

$0.33

0.730

627

Level 2 Type B Emergency Visits

V

 

$61.45

$64.63

$3.18

5.175

628

Level 3 Type B Emergency Visits

V

 

$88.64

$93.97

$5.33

6.013

629

Level 4 Type B Emergency Visits

V

 

$159.16

$130.96

($28.20)

-17.718

630

Level 5 Type B Emergency Visits

V

 

 

$248.47

$248.47

 

659

Hyperbaric Oxygen

S

$99.23

$103.56

$106.66

$3.10

2.993

8002

Level I Extended Assessment & Management Composite

V

$351.04

$375.70

$380.38

$4.68

1.245

8003

Level II Extended Assessment & Management Composite

V

$638.66

$674.73

$702.92

$28.19

4.177

G0396

Alcohol/subs interv

15-30mn

S

$19.92

$26.85

 37.73

10.88 

40.52 

G0397

Alcohol/subs interv >30 min

S

$19.92

$26.85

 37.73 

 10.88

40.52 

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