Health Information Management

News: AHA supports proposed two-midnight changes; opposes OPPS conversion factor cut

CDI Strategies, September 3, 2015

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The American Hospital Association calls CMS’ proposed 2% reduction in outpatient payments “ill-conceived,” and “founded on questionable assumptions,” in an August statement responding to the 2016 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.

The AHA expressed disapproval for many of the proposed changes, including CMS’ lack of transparency in how the percentage was calculated, adding that “unexpectedly high” data in 2014 may not be due to permanent changes in hospital coding and billing practices, but rather “CMS’s unclear and frequently shifting billing instructions.”

The AHA urged CMS to use the recent recommendations in the Institute of Medicine’s Vital Signs report to help streamline the measures in the outpatient quality reporting program, adding that OPPS measures should focus on national priority areas for improvement applicable to the entire healthcare system.

The feedback was not entirely negative, however. The AHA applauded CMS for acknowledging the importance of physician judgment and individual patient needs in the hospital admission decision-making process, as well as the proposed changes for the two-midnight rule. They did request that CMS extend the partial enforcement delay of the two-midnight policy through March 31, 2016. CMS announced on August 12 that they would extend the partial enforcement delay through the end of the year.


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