The Centers for Medicare & Medicaid Services today issued calendar year 2014 proposed rules for the outpatient prospective payment system and ambulatory surgical centers and for the physician fee schedule. The OPPS/ASC rule would increase hospital outpatient payment rates by 1.8%, based on the projected inpatient market basket increase of 2.5% minus a proposed multifactor productivity adjustment of 0.4 percentage point and a 0.3 percentage point adjustment required by the Patient Protection and Affordable Care Act. The rule also proposes to end the direct supervision enforcement delay for critical access hospitals and small rural hospitals on Dec. 31, a proposal strongly opposed by the AHA. In addition, the rule would collapse the current five levels of outpatient visit codes with a single code for each type of outpatient hospital visit, including clinic and Type A and Type B emergency department visits; package seven new categories of supporting items into the payment for the primary service; and create 29 comprehensive ambulatory payment classifications to replace existing device-dependent APCs. Without congressional action, the PFS rule would reduce Medicare physician payments by an estimated 24.4% on Jan. 1. Comments are due to CMS by Sept. 6 and final rules are expected by Nov. 1. The AHA will send members a Special Bulletin with highlights on the rules' key provisions tomorrow followed by detailed Regulatory Advisories in the next several weeks.