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Medicare Payments for Off-Campus Care Slashed by 40%

The Centers for Medicare & Medicaid Services finalized its 2018 physician fee pay rule, which slashes the amount Medicare will pay for healthcare services to 40%, when obtained at off-campus medical facilities that are owned by hospitals.

The new rule is expected to create $12 million in savings for CMS. Pain management treatment, various x-rays and radiation therapies, as well as some behavioral health services, will be affected by the rate cut.

The 40% reimbursement number is an increase from the 25% CMS previously proposed. However, hospitals are still concerned.

Tom Nickels, executive vice president of the American Hospital Association, said the rule “will adversely impact patient access to care by reducing Medicare rates for services hospitals provide in new off-campus hospital clinics. We are particularly concerned about the impact on rural and vulnerable communities that do not have sufficient access.”

The 2018 rule reverses a rule finalized under the Obama administration in 2016 that paid hospital off-campus facilities the same as hospital-based outpatient departments if they started billing Medicare after Nov. 2, 2015. That rule encouraged hospitals to acquire physician practices in large numbers. Hospitals contend the acquisitions expanded their reach, especially in underserved areas, and providers believe the new rule will affect patient access.

“The CMS proposal will result in an unsustainable payment rate that will further reduce access for people in chronically underserved communities, healthcare deserts, and the hospitals on which they rely,” said Dr. Bruce Siegel, CEO of America’s Essential Hospitals.

For questions, comments or concerns, please contact Jennifer Duell Popovec

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