2009-07-17

The Centers for Medicare and Medicaid Services (CMS) proposed its Hospital Outpatient Prospective Payment System (HOPPS) rule for 2010. CMS projects that overall CY 2010 payments to the more than 4,000 hospitals subject to HOPPS will be $31.5 billon. This reflects an update of the hospital market basket of 2.1 percent. Hospitals are required to participate in a quality reporting program in order to be eligible for the full update.

ASH has developed a detailed analysis of the key issues and potential impact on hematology. Specific areas that ASH members should be aware of include:

Payment for Hematological-Related Services - The payments for blood related procedural codes generally will see modest increases in 2010 compared to 2009. This is also the case with the high volume drug administration services. Payment changes for blood products will vary in 2010. In general, the payment for high volume blood products will see some modest losses for some products and, for a few codes, some modest gains. The payment for very low volume blood products is very unstable with some very large gains and some very large losses.

Allogenic Bone Marrow Transplant Procedures - CMS is proposing to revise the classification of allogeneic bone marrow transplant procedures including the related harvesting procedure as payable only as inpatient procedures and remove them from the list of covered HOPPS procedures.

Quality Reporting – CMS is proposing to maintain the quality measures from the 2009 program. Newly proposed for 2010 is a validation program that will require hospitals to supply requested medical documentation to a CMS contractor for purposes of being validated. The results of the validation will not affect the CY 2011 payment update.

The rule also clarifies some confusion regarding Medicare's physician supervision requirements for therapeutic services and provides for a variety of updates to payment for drugs and radiopharmaceuticals.

ASH will be providing comments to CMS by the August 31 deadline. If you have any specific concerns or questions, please contact please contact ASH Senior Manager, Policy & Practice, Carol Schwartz at 202-776-0544.

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