Health Information Management

CMS requests information on potential new payment models

APCs Insider, February 14, 2014

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Over the years, CMS has been steadily aligning OPPS more toward its inpatient counterpart, IPPS, and away from a fee-for-service system. Despite not finalizing some of its more radical packaging proposals for 2014, CMS made clear that it would further refine and reintroduce some of those proposals in subsequent years.
For example, in the 2014 OPPS Proposed Rule, CMS considered 29 new device-dependent comprehensive APCs. These would act like a mini-DRG, with a single APC payment made for all of the separate services reported. CMS said that due to the operational complexity of the proposal, it would be an administrative burden to implement in 2014 and would be reintroduced for 2015.
This week, CMS signaled it's considering even more packaging by requesting information on two new potential payment models for specialist practitioners, one for procedural episode-based treatment and another for complex chronic disease treatment. CMS is already working on a new payment model for oncology services.
CMS is hoping that providers will help define episodes of care for a variety of treatments based on two factors: a clinical dimension, including the services or clinical conditions that compose the episode; and a time dimension that reflects the beginning and end of an episode.
CMS will include the following considerations for each treatment:
  • Historical variation in utilization and payment
  • Extent to which this variation is under the practitioner’s control
  • Ease with which the practitioner responsible for the episode can be identified
If it wasn't clear before, this request for information shows that CMS is serious about making significant changes to OPPS to package together services. This is a great opportunity for providers to have input at an early stage of the process and make sure that CMS is aware of all of the costs and other factors associated with their specialty-specific treatments.
CMS will be accepting comments through March 13, so visit its website or contact for more information.


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