ACR Meets With CMS to Discuss HOPPS

The ACR team met this week with CMS to discuss the Hospital Outpatient Prospective Payment System (HOPPS). Our team, led by Jim Rawson, M.D., chair of our HOPPS committee, also included me, Pam Kassing, Katie Keysor and two talented consultants from the Moran Company, Rachel Feldman and Mark Desmarais.

Our first task was to help CMS in their task of assigning the new 2014 radiology CPT codes to the proper Ambulatory Payment Classification (APC) so they are paid properly in the hospital outpatient setting. The new codes describe breast interventions, abscess drainage catheter placement, vascular embolization and vascular stent placement. These code families are complex bundled combinations of existing codes, so the American College of Radiology’s clinical input is crucial. Our consultants help us evaluate the historical claims data, calculating the proper geometric mean costs to support our APC recommendations.

Our second task was to again express our grave concerns over the application of new CT and MR cost center data to the Outpatient Prospective Payment System, since this will secondarily impact physician payments in the Medicare Physician Fee Schedule thanks to the Deficit Reduction Act. We emphasized that the hospital cost data for these centers is woefully inadequate and not worthy of application in any setting.

Overall, the meeting was positive and I am optimistic that our APC recommendations will be accepted. I am also hopeful that our comments on the CT/MR cost centers were understood and will convince them to abandon this flawed proposal. We expect to know how CMS will rule on these concerns towards the end of November. My thanks to the whole team.

Author – Ezequiel Silva, M.D., co-chair Commission on Economics   

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One thought on “ACR Meets With CMS to Discuss HOPPS

  1. SGR Replacement Policy Draft Includes Use of Clinical Decision Support.

    Draft coming out of the Senate Finance and House Ways and Means Committees takes a more aggressive track but follows the template of the SGR bill that passed unanimously by the House Energy and Commerce Committee. Both versions include CDS for medical imaging. This is a very important step in what will be a long journey. As medicine and reimbursement changes, it is vital to keep radiologist involved in the health care value chain. CDS underscores that we stand for using the right imaging test for the right patients at the right time. The concept emphasizes that radiologists are not just image interpreters but also important components in any health care enterprise. CDS is just the tool. Appropriating medical imaging resources centers on the expertise and experience of the radiologist. We do so much more than just image interpretation.
    We still have a very long way to go. We await the challenges of pay fors and process. Today’s success in planting a flag for Radiology in this legislative draft is the result of lots of hard work by our legislative team. They have been working tirelessly on our behalf.
    Radiology is the only specialty to get specific language included. This landmark is due to the hard work of the leaders and staff at the ACR.

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