Thread by @signaturedoc

While many concentrate on the Physician Fee Schedule Rule, I found some nuggets in the OPPS Rule. Here is a summary thread @BetsyNicoletti @BillFoxMD @SEricksonACP @YoungstromNina @AmerCollPhyAdv

Price transparency moves further ahead. Hospitals will need to post all charges in a standardized way; no more Excels with only internal codes and indecipherable abbreviations

Hospitals must also post all payer-specific negotiated rates for every insurer (can you say "Lawsuit over trade secrets"?) Hospitals must post the prices of 300 common shoppable services with easy method to search them. CMS also designated 70 services as required

Price transparency also applies to every hospital, even those who do not accept any gov't payment. Don't know how many of those exist. There will be civil monetary penalties set for non-compliance.

Physician Assistants will be equivalent to Nurse Practitioners as relates to physician supervision. No more direct supervision of their practice. (Wait, this may be PFS rule but it's important.)

Non-diagnostic therapeutic services at all hospitals incl CAHs will be general supervision. Big win for CAHs who have had this looming over them for years on end.

When CMS removes any surgery from inpatient only list, no RAC audits on status for 1 yr. BFCC-QIOs can audit for status but cannot recoup funds- education-only audit. No mention if adits for medical necessity of surgery itself can proceed.

Total Hip Replacement to be removed from Inpatient Only list. Will mean can be done inpatient or outpatient (and we get into the mess of what qualifies for inpatient admission and how badly will the auditors mess up the audits like @BeneProtection did this year)

Total knee replacement to be allowed at ASCs. Patients must be expected to be discharged prior to midnight. CMS may only allow ASCs that already do TKAs on commercial patients to do surgery.

Cardiac interventions will be allowed at ASCs- stents, angioplasty. Want comments on allowing atherectomy, CTO, bypass graft stents. This is surprising since they just allowed diagnostic caths starting in 2019 and few are doing that.

Speaking of ASCs, CMS will track unplanned ED, Obs and inpatient visits to hospitals within 7 days after an ASC surgery to monitor quality.

Prior auth to be required for blepharoplasty, Botox, rhinoplasty, panniculectomy, vein ablation as of 7-1-20

They also ask for comments on changing the cost reporting and chargemaster pricing methods.

Of course every rule addresses payment rates and conversion factors; I don't bother with that because it does not affect anything clinical or operational (and I don't understand it)

That's all for now