The AAMC Sept. 11 submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the proposed Hospital Outpatient Prospective Payment Rule, (82 FedReg 33558). The following are AAMC's major comments:
CMS proposed to cut payments to 340B DSH hospitals for non-pass through outpatient drugs from the current ASP (average sales price) + 6% to ASP minus 22.5% starting in Jan. 2018. The AAMC strongly opposed this proposal and urged CMS to rescind the proposal. The 340B Program was designed to allow safety-net hospitals, many of which are teaching hospitals, to support programs to help low-income, vulnerable patients have access to needed care at no cost to taxpayers. The proposal represents a significant payment reduction that will undermine the purpose and benefits of the 340B Program, while crippling the ability of 340B hospitals to provide support and programs to serve vulnerable and low-income patients. In addition, CMS did no independent analysis to support this proposal, or to understand the financial impact which the law requires. Instead, it relied on a 2015 Medicare Payment Advisory Commission (MedPAC) report. The AAMC also submitted a legal memorandum prepared by attorney Mark D. Polston, King & Spalding, that showed that CMS does not have the statutory authority to make this change in payments to 340B DSH hospitals.
CMS also proposed to remove Total Knee Arthroplasty (TKA) from the Inpatient Only List (IPO). In making this proposal, CMS has not addressed the ways in which it will adversely affect hospitals participating in Medicare bundled payment models, such as in the Comprehensive Care for Joint Replacement (CJR) and in the Bundled Payments for Care Improvement (BPCI). The AAMC commented that prior to finalizing the proposal, CMS must establish a methodology to adequately risk-adjust target prices for the shift in populations between surgery setting. As this must occur through notice and comment rulemaking, it is premature for CMS to finalize its proposal. The AAMC provided CMS with a proposed payment methodology to be used during a transition from having TKA on the inpatient only list to removing it from the list.
AAMC also encouraged CMS to account for socio-demographic risk factors in the hospital Outpatient Quality Reporting (OQR) program.