Becker's Hospital Review

11 CFO / FINANCE 8 Things to Know About the Final OPPS Rule for 2018 By Ayla Ellison C MS has released its final 2018 Medi- care Outpatient Prospective Payment System rule, which cuts payments to hospitals under the 340B Drug Pricing Pro- gram and authorizes Medicare to reimburse for knee replacement surgeries performed in outpatient facilities. Here are eight things to know about the 1,133-page final rule. Payment update 1. CMS will increase OPPS rates by 1.35 per- cent in 2018. e agency arrived at the rate increase through the following updates: a positive 2.7 percent market basket update, a negative 0.6 percent update for a productivity adjustment, and a negative 0.75 percent up- date for cuts under the ACA. 2. After considering all other policy chang- es in the final rule, CMS estimates OPPS payments to providers will total $70 billion in 2018, an increase of about $5.8 billion from 2017. 340B program changes 3. CMS finalized a proposal to pay hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B pro- gram. at's compared to the current pay- ment rate of average sales price plus 6 per- cent. e current payment rate will continue for vaccines, and sole community hospitals in rural areas, children's hospitals and prospec- tive payment system-exempt cancer hospitals will be excluded from this payment adjust- ment for 2018. 4. CMS is implementing this policy in a bud- get-neutral manner by offsetting the project- ed $1.6 billion decrease in drug payments by redistributing an equal amount for non-drug items and services within the OPPS. 5. Regarding the payment cuts, American Hospital Association Executive Vice Pres- ident Tom Nickels said, "CMS' decision in today's rule to cut Medicare payments to hospitals for drugs covered under the 340B program will dramatically threaten access to healthcare for many patients, including unin- sured and other vulnerable populations. We strongly urge CMS to abandon its misguided 340B rule, and instead take direct action to halt the unchecked, unsustainable increases in the cost of drugs." 6. e AHA is joining two other hospital lob- bying groups — America's Essential Hospitals and the Association of American Medical Colleges — in a lawsuit against CMS over the payment cuts for 340B drugs. Update to inpatient-only list 7. e Medicare inpatient-only list includes procedures that are only paid for under the Hospital Inpatient Prospective Payment Sys- tem. Each year, CMS reviews the list to de- termine whether any procedures should be removed from or added to the list. For 2018, CMS is removing total knee arthroplasty from the IPO list. CMS also removed five other pro- cedures from the IPO list and added one. Hospital Outpatient Quality Report- ing Program changes 8. Under the final rule, CMS is removing six measures from the Hospital Quality Report- ing Program for the 2020 payment determi- nation and subsequent years. e measures CMS is removing are: • OP-1: Median time to fibrinolysis • OP-4: Aspirin at arrival • OP-20: Door to diagnostic evaluation by a qualified medical professional • OP-21: Median time to pain management for long bone fracture • OP-25: Safe surgery checklist use • OP-26: Hospital outpatient volume data on selected outpatient surgical procedures n SSM Health Lays Off 350 Employees By Ayla Ellison S t. Louis-based SSM Health laid off 350 employees, or about 1 percent of its 35,000-person workforce, on Nov. 8, ac- cording to the St. Louis Post-Dispatch. In addition to the layoffs, an undisclosed num- ber of positions will be lost to attrition. In a statement to the St. Louis Post-Dispatch, SSM Health said the cuts will help ensure "long- term sustainability" for the system. SSM did not disclose what positions would be eliminated. SSM Health has operations in Illinois, Missouri, Oklahoma and Wisconsin. The system includes 20 hospitals, 63 outpatient care sites, two nurs- ing homes and home care and hospice ser- vices. SSM also has a pharmacy benefit com- pany, an insurance company and two ACOs. n Alabama Hospital to Close, Lay Off 87 Employees By Ayla Ellison L akeland Community Hospi- tal, a 59-bed hospital in Ha- leyville, Ala., plans to close by the end of 2017. Officials said the hospital is closing due to dwindling reimbursement. "Reduced reimbursement from the government as well as commercial insurers have taken a tremendous toll on rural hospitals across the nation," stated a press release from the hospital. "Lakeland Commu- nity Hospital has been greatly im- pacted and is on track to have re- imbursements reduced by nearly $2 million dollars." Hospital CEO Debbie Pace said officials explored "every viable option" before making the deci- sion to close Lakeland Commu- nity Hospital, which is the only hospital in Winston County, ac- cording to The Cullman Times. Approximately 87 employees will be affected by the closure. All employees will continue to receive pay and benefits until the hospital shuts down. According to research from the North Carolina Rural Health Re- search Program, Lakeland Com- munity Hospital will be the sixth rural hospital in Alabama to close since 2010. n

• Cover