What is it?
Last week, we discussed the “Site-Neutral Rule,” which would reduce Evaluation and Management charges for off-campus outpatient programs, including wound care and hyperbaric medicine centers. This week, 38 Hospitals sued Health and Human Services (HHS), challenging the rule. The lawsuit alleges that HHS Secretary Alex Azar exceeded his authority when this rule was implemented January 1, 2019.
What Does It Mean?
The Bipartisan Budget Act of 2015 defined exempted off-campus provider-based departments and their method of payment. With the passage of that Act, Congress determined that off-campus wound centers operating (dropped bills) before November of 2015 were exempted from site-neutral payments. The recent changes to the site neutral rule by HHS in effect negates the Bipartisan Budget Act of 2015 as it disregards exempted status, leveraging the site-neutral penalty on all off-campus wound centers, regardless of when the facility began operations.
Why Does It Matter?
Bottom Line: If this section of the final rule stands, it means that CMS can develop rules and require hospitals to meet them, and then simply change the rule once hospitals have complied in order to to save money. In this case, this could mean annual savings of $380 million. This puts outpatient centers and the patients they serve at risk. With these hospitals, as well as the AHA filing lawsuits, scrutiny on this tactic will increase in an attempt to ensure that hospitals are not penalized in the future.
Whether these lawsuits are successful or not, I still feel that the value of existing centers that meet the exempt status will increase. Attention to the operations and business components of existing wound centers should be a priority for hospitals. If you need help, reach out to Melissa Bailey to talk about how a 20 Point Assessment might help.