Penn. lawmakers call for fair Medicare/Medicaid outpatient payment updates

In league with more than 100 fellow U.S. Representatives, three Pennsylvania Congressmen appealed to the Centers for Medicare & Medicaid Services (CMS) to provide a positive payment update for hospital outpatient services on Monday.

The request came after the CMS proposed an outpatient prospective payment system (OPPS) rule for calendar year 2016 that included cuts reducing net hospital outpatient payments by 0.2 percent. The cuts were a consequence of what CMS called “inappropriate inflation in … payment rates” resulting from its own overestimation of packaged laboratory payments as well as underestimation for lab fees paid outside the OPPS.

U.S. Reps. Bob Brady (D-PA), Brendan Boyle (D-PA) and Keith Rothfus (R-PA) urged CMS to reconsider its approach and to provide transparency regarding its inaccurate estimates.

“Medicare already pays providers less than the cost of care,” the Congressmen stated. “Prescribing a negative update…will only make it more difficult for hospitals to serve their patients and their communities….”

The Hospital & Healthsystem Association of Pennsylvania (HAP) deemed that the CMS' rule proposal contains harmful cuts.

The Congress members’ letter advised CMS that they were both surprised and disappointed. With figures indicating that U.S. hospitals would be paid $43 million less in 2016 than 2015, the communication implored CMS to work with the legislature “to ensure that all annual updates remain positive.”

HAP first stressed the reduction percentage as a major area of concern in comments submitted to CMS in August.

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