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Eli's Rehab Report

Industry Notes:

Two Radical Changes in OPPS

The Centers for Medicare & Medicaid Services (CMS) released the Outpatient Prospective Payment System (OPPS) proposals on July 6. The agency is focusing on improving patient care through some of its proposed policies, according to a CMS fact sheet.

“The items in this proposal are designed to improve care and value when Medicare beneficiaries receive care in an outpatient setting,” said Andy Slavitt, Acting CMS Administrator in a July 6 CMS press release. “Today’s proposed updates better support physicians in providing beneficiaries with the right care at the right time.”

Pain management: CMS is “developing alternative pain management questions, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey data on all dimensions of care, including pain management, will continue to be publicly reported under the Hospital Inpatient Quality Reporting (IQR) Program in recognition that pain control is an important aspect to delivering quality care,” according to the CMS fact sheet.  

In line with the official policy of curbing opioid abuse, CMS has proposed removing the pain management dimension from the HCAHPS survey of the Hospital VBP Program “to eliminate any potential financial pressure clinicians may feel to overprescribe pain medications,” the fact sheet states.

“Appropriate pain management includes communication with patients about pain-related issues, setting expectations about pain, shared decision-making, and proper prescription practices,” according to the fact sheet.

Setting matters: If you provide therapy services in a hospital-owned, off-campus outpatient department, then you will no longer be paid through OPPS in 2017. However, the American Physical Therapy Association (APTA) doesn’t expect physical therapists (PTs) to be significantly impacted, according to a July 7 press release.

Cost cutting: Currently, when some services as well as items are provided in a hospital’s outpatient department instead of the physician’s office, Medicare pays a higher rate. There is also the fear that this higher pay could be encouraging “hospitals to acquire physician offices in order to receive the higher rates… The CMS Office of the Actuary estimates that these changes should reduce OPPS spending by approximately $500 million in 2017,” according to the fact sheet.

Resources: The fact sheet on this proposed rule is available at: The press release can be viewed at: