Web Exclusive: CMS releases proposed 2011 hospital outpatient regulations

By Sheila Madhani, assistant director of health policy

The Centers for Medicare and Medicaid Services (CMS) posted the proposed rule governing payment policies and rates for the Medicare hospital outpatient payment system (HOPPS) for calendar year 2011 on its website on July 2, 2010. The rule also implements certain provisions of the Patient Protection and Affordable Care Act. 

Radiation oncology highlights
Initial analysis of the rule finds the following proposals related to hospital outpatient payment for radiation oncology services:

• LDR prostate brachytherapy will continue to be paid with the composite APC methodology, proposed payment is a slight increase.
• Image guided radiation therapy (IGRT) services will continue to be packaged according to current CMS methodology.
• Proposed decrease in payment for treatment delivery CPT code 77406. 
• Proposed payment for treatment devices reflect a slight increase and a decrease is reflected in proposed payment for protons.
• Proposed decrease in payments for HDR brachytherapy treatments.
• Brachytherapy sources proposed payment changes vary.
• For radioimmunotherapy, proposed payments for Zevalin reflects an increase, while proposed payments for Bexxar reflects a decrease.
• Eleven cancer hospitals will receive a hospital-specific payment adjustment to offset their high costs of treating cancer patients.

In addition, CMS invites public comment on the topic of exempting critical access hospitals (CAHs) from a direct supervision requirement for outpatient therapeutic services.

ASTRO will submit comments to this proposed rule by the August 31 deadline. The final hospital outpatient rule will be published around November 1 and will be effective for services rendered on or after January 1, 2011. The regulations are posted on the CMS website.