On November 20, WSHA provided hospitals with an analysis of the Calendar Year 2016 Medicare outpatient prospective payment system final rule. WSHA also provided facility-specific impact reports to hospital Chief Financial Officers. The new payment rates include a 2.1 percent market basket increase that is offset by an ACA-mandated reduction of 0.7 percent and an additional adjustment reduction of 2 percent due to lab services that should have been bundled being paid separately in error. In aggregate, Washington hospitals will experience a slight increase in payment compared to 2015, mainly due to changes in wage index. The scope of impact for Washington hospitals ranges from a negative 7.5 percent to a positive 9.5 percent.
The rule also includes:
- Renumbering of APCs in order to better group clinical families.
- Implementation of 10 new Comprehensive Ambulatory Payment Classifications (C-APCs) that bundle all payments for certain device-dependent procedures.
- Expansion of the list of services to be packaged into APCs as opposed to separately paid.
- For IPPS, revision of the “Two-Midnight Rule” for reasonable expectation requirement and use of Quality Improvement Organizations (QIOs) as the first line for auditing.
- Updated payment rates and policies for Ambulatory Surgical Centers (ASCs).
