News: 2021 OPPS final rule released

CDI Strategies - Volume 14, Issue 55

CMS published the calendar year (CY 2021) Outpatient Prospective Payment System (OPPS) final rule. The OPPS final rule will continue cuts to the 340B drug program, expand coverage for some procedures in ambulatory surgery centers, and gradually eliminate all 1,700 inpatient-only procedures under the OPPS, HealthLeaders Media reported.

CMS said that eliminating the inpatient-only list—starting with about 300 primarily musculoskeletal-related services, effective January 1, 2021—will give patients and physicians more freedom to choose an appropriate and potentially cost-saving care setting.

In the short term, CMS said providing care in an outpatient setting during the public health emergency will also improve access to care for non-COVID-19 patients.

Eliminating the inpatient-only list will remove possible incentives to send patients to hospitals for higher priced procedures that could actually be done in lower-cost outpatient settings, HealthLeaders Media reported. The rule aims to allow doctors and patients to make decisions about the most appropriate site of case, based on what makes the most sense for the course of treatment and the patient.Top of Form

The final rule also adds 11 procedures to the ambulatory surgery center covered procedures list (ASC CPL), including total hip arthroplasty, and revises the criteria used to add surgical procedures to the ASC CPL, HealthLeaders Media reported.

"Using our revised criteria, we are adding an additional 267 surgical procedures to the ASC CPL beginning January 1, 2021," CMS said. "Finally, we are adopting a notification process for surgical procedures the public believes can be added to the ASC CPL under the criteria we are retaining."

Editor’s note: This article originally appeared in HealthLeaders Media. The 2021 OPPS final rule can be found here. The CMS fact sheet on the OPPS final rule can be found here