House Passes Healthcare Bill With HOPD Provisions

The U.S. House of Representatives passed omnibus healthcare legislation Wednesday that would preserve payment rates for more off-campus hospital outpatient departments, among other provisions sought by hospitals.

The 21st Century Cures Act, which the House passed on a bipartisan vote of 392 to 26, included a provision that would expand the number of hospital outpatient departments (HOPDs) that could continue to receive standard Medicare HOPD payment rates, instead of the lower rate required for new off-campus HOPDs. The bill would achieve that by extending a date that grandfathered payments for off-campus HOPDs under the 2015 Bipartisan Budget Act from Nov. 2, 2015, to Dec. 31, 2016, or 60 days after the new measure’s enactment, whichever is later.

Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges (AAMC), said in a written statement that he was “gratified to see that off-campus teaching hospital outpatient departments already under development will continue to receive Medicare outpatient payment rates rather than the payment cuts imposed on new outpatient departments.”

Other highly sought provisions of the bill included an adjustment to the Hospital Readmissions Reduction Program (HRRP) to account for socioeconomic status. Specifically, the bill would require creation of a transitional risk adjustment methodology to serve as a proxy of socioeconomic status for the HRRP, followed by permanent implementation of a more refined methodology after completion of an analysis required by an earlier law, the Improving Medicare Post-Acute Care Transformation Act of 2014.

Hospital advocates had urged the change to address concerns that many readmissions are caused by poverty-related factors beyond the hospitals’ control, especially in the cases of hospitals that serve large shares of low-income patients. Among research bolstering that point was an October study in Health Affairs that found “most readmissions after the seventh day post-discharge were explained by community- and household-level factors beyond hospitals’ control.”

“Adjusting the HRRP for the challenges vulnerable patients face puts essential hospitals on a level playing field when evaluating readmission rates,” Bruce Siegel, MD, president and CEO of America’s Essential Hospitals, said in a written statement. “It also can break a vicious circle in which penalties further deplete the already scarce resources essential hospitals have to reduce readmissions. In such cases, the HRRP worsens, rather than fixes, the problem.”

The Centers for Medicare & Medicaid Services (CMS) had resisted such an adjustment over concerns that it would allow hospitals to deliver low-quality care to low-income patients without penalty.

Blair Childs, a senior vice president for Premier, a hospital quality improvement company, hailed provisions of the bill “that will enhance the [Food and Drug Administration] approval process to advance the entry of new drugs and devices to the market with a goal of creating more competition and lower prices.”

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