AdvaMed Offers Praise as CMS Moves to Avert Outpatient Payment Cut for Technology

Originally Published MDDI December 2001

A final rule issued by the Centers for Medicare & Medicaid Services (CMS) regarding outpatient prospective payment "represents a significant step forward in protecting Medicare patients' access to innovative medical technologies, drugs, and biologics in the outpatient setting," according to AdvaMed.

Considered to be a major policy shift, the action by CMS effectively avoids deep cuts in temporary "pass-through" payments for new medical technologies by moving 75% of technology costs into the base outpatient payment bundles and by applying pass-through cuts only to the remaining costs. As a result, the net payment cuts for medical technology will be far lower than the 80.7% pass-through cut that would have been made, according to AdvaMed.

Says AdvaMed President Pamela G. Bailey, "This final rule offers real hope to the patients, physicians, and hospitals across the country who have raised concern that Medicare's proposed cuts would force patients into the more costly and less convenient inpatient setting." Bailey adds that, "to make these solutions a reality, CMS and Congress must continue moving in the new direction they have taken today."

AdvaMed believes that it is critically important for CMS to ensure adequate reimbursement for new technologies as it shifts pass-through payments into the base outpatient payment categories.

Bailey also indicates that AdvaMed is pleased that CMS has voiced its support for legislation to allow the agency to use funds from the outpatient "outlier" pool to further reduce payment cuts. "We are hopeful Congress will enact this change soon to support full patient access to advanced outpatient care," she says. Bailey adds, "Congress' goal in creating the pass-through program was to ensure that CMS moves to an outpatient program that provides adequate reimbursement for the innovative medical technologies that patients need."

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