On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Outpatient Prospective Payment System (OPPS) final rule.
In the final rule, the CMS finalized a 3.1% increase to payment rates for items and services paid under the OPPS, which is a 0.3% increase from the 2.8% in the proposed rule. Hospitals must meet the hospital outpatient quality reporting requirements to be eligible for the full update. The agency will use the most recent updated cost reports and claims data available for the CY 2024 OPPS ratesetting. The rule finalized reimbursement of 340B Drug Pricing Program-acquired drugs at the average sales price plus 6%. Additionally, the agency finalized its proposals around biosimilar packaging exceptions, dental services, intensive outpatient services, payment for intensive cardiac rehabilitation services provided by an off-campus, nonexcepted provider-based department, and hospital price transparency.
In the Outpatient Quality Reporting (OQR) program, the CMS finalized the adoption of two new measures:
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Risk-Standardized Patient-Reported Outcome-Based Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) in the HOPD Setting (THA/TKA PRO-PM); and
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Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Hospital Level - Outpatient) electronic clinical quality measure] and modification of three existing measures (including the COVID-19 vaccination rate for health care personnel measure).
The agency did not finalize the readoption of the Hospital Outpatient Volume Data on Selected Outpatient Procedures measure or the removal of the Emergency Department Left Without Being Seen measure.