Highlights of the Medicare Outpatient Hospital Payment Final rule for 2010

Hospital OPDs will get an average of 2.1 % annual inflation update from Medicare.  Expenditures are projected to be $32.2 billion in CY 2010. 

• Payment:  APC Codes for Hospital ED visits show slight increase with two exceptions  (see attached table)
  • Type A ED facility payments increase by 2 percent
  • For 2010, CMS added a Level V Type B APC, which is $184 less than the Type A level V payment. (Last year, Level V Type B was paid at the same level as Type A)
  • CMS is reducing payment for trauma response with critical care.  (While the $101 is a significant reduction, payment from 08 to 09 increased by over $600.  CMS has more claims to review and adjusted median costs accordingly.)

• Quality Reporting Measures:  OPPS payment inflation update is reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements starting from 2008. 
  • No new quality measures were proposed for 2010
  • Hospitals will continue to report data on seven quality measures of emergency department and peri-operative surgical care. 
  • CMS is considering an ED throughput measure for CY 2012 payment determination, "Median Time from ED Arrival to ED Departure for Discharged ED Patients." The measure specifications can be found at http://www.qualitynet.org/ in Appendix P of the specifications manual under Hospital –Outpatient.
  • CMS is establishing a process to make HOP quality measure data publicly available as early as June 2010

• Health care Acquired Conditions:  As we requested, CMS did not propose any measures for 2010 acknowledging the complexity of implementation in the outpatient setting as well as lack of analysis of the current data from the inpatient hospital acquired conditions initiative started in 2008

• Facility Coding for ED Visits: CMS is content to allow hospitals to use their own coding guidelines, again citing stability of claims distribution over the past several years.

Outpatient Payment for APCs of Interest to EM

APC	Group Title	SI	Payment Rate 2008	Payment Rate 2009	Proposed Payment Rate 2010	Payment Change 2009 - 2010	% Payment Change 2009 - 2010
609	Level 1 Type A Emergency Visits	V	$50.76	$52.66	$53.65	$0.99	1.879
613	Level 2 Type A Emergency Visits	V	$83.67	$86.14	$88.35	$2.21	2.565
614	Level 3 Type A Emergency Visits	V	$132.17	$136.70	$140.27	$3.57	2.701
615	Level 4 Type A Emergency Visits	V	$212.59	$217.91	$225.29	$7.38	3.386
616	Level 5 Emergency Visits	V	$315.51	$323.90	$330.75	$6.85	2.114
617	Critical Care	S	$466.02	$485.39	$508.56	$23.17	4.773
618	Trauma Response with Critical Care	S	$330.28	$935.12	$802.90	($132.22)	-14.139
626	Level 1 Type B Emergency Visits	V		$45.18	$45.51	$0.33	0.730
627	Level 2 Type B Emergency Visits	V		$61.45	$64.63	$3.18	5.175
628	Level 3 Type B Emergency Visits	V		$88.64	$93.97	$5.33	6.013
629	Level 4 Type B Emergency Visits	V		$159.16	$130.96	($28.20)	-17.718
630	Level 5 Type B Emergency Visits	V			$248.47	$248.47
659	Hyperbaric Oxygen	S	$99.23	$103.56	$106.66	$3.10	2.993
8002	Level I Extended Assessment & Management Composite	V	$351.04	$375.70	$380.38	$4.68	1.245
8003	Level II Extended Assessment & Management Composite	V	$638.66	$674.73	$702.92	$28.19	4.177
G0396	Alcohol/subs interv 15-30mn	S	$19.92	$26.85	37.73	10.88	40.52
G0397	Alcohol/subs interv >30 min	S	$19.92	$26.85	37.73	10.88	40.52