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AHA: Outpatient payment proposals need more analysis, validation

September 13, 2013

AHA today expressed major concerns with outpatient prospective payment system proposals for calendar year 2014 that would create seven new payment packaging categories and comprehensive ambulatory payment classifications, and collapse the clinic and emergency department visit codes. It also voiced continued reservations about the accuracy of data included in the proposed rule’s analysis. “While the AHA generally supports payment reforms that lead to larger units of payment, such as bundled payment, we cannot support the Centers for Medicare & Medicaid Services’ comprehensive APCs and packaging proposals for implementation in CY 2014,” AHA Executive Vice President Rick Pollack said in comments submitted to the agency. “Our reservations about the data, the complexity of these proposals and the short timeframe until implementation cause us to be wary about the sweeping redistribution of funds across hospitals that would result from implementing these fundamental changes to the OPPS. Therefore, we believe that the hospital field and CMS would benefit from more time to analyze and validate the technical changes necessary to make these policies possible, as well as to study the impacts they would have on individual hospitals.” AHA also recommended that CMS not implement at this time its proposal to collapse the hospital outpatient visit codes to a single code for each type of visit. AHA submitted comments on other aspects of the proposed rule last week.