Final outpatient rule takes first step to ensure continued access
December 14, 2001
Medicare moved to protect patient access to innovative outpatient care by averting deep (80%) cuts in outpatient payment for many new medical technologies in a final rule published Nov. 30. However, some advanced technologies, such as a breakthrough treatment for prostate cancer, still face large payment cuts under the rule. Congress now must act on Medicare's recommendation to tap existing "outlier" funds to reduce pass-through payment cuts and ensure continued access to high-quality outpatient care. Prostate cancer patients may be denied access to advanced treatment option under final Medicare rule. Prostate cancer is the most common type of cancer found in American men, other than skin cancer, according to the American Cancer Society. There will be about 198,100 new cases of prostate cancer in the United States in the year 2001, and about 31,500 men will die. Thanks to advances like cryosurgery, a growing number of men with prostate cancer and other prostate conditions can receive effective treatment in the hospital outpatient setting. With cryosurgery, small probes are inserted into the prostate to destroy diseased tissue by freezing it. This technology avoids the difficulties and complications of surgery and enables patients to recover more quickly. Medicare's final outpatient rule, however, would significantly cut outpatient reimbursement for cryosurgery, meaning hospitals would lose several thousand dollars for the procedure. As a result, many patients likely would be forced to undergo more invasive, and expensive, surgery procedures and would not have access to this advanced therapy. In addition to substantial reimbursement reductions that some technologies like cryosurgery face, new medical technologies overall would take a payment cut of about 30% under the final rule, according to CMS estimates.Congressional action on use of outlier funds is needed to ensure continued patient access to advanced outpatient care. To reduce the payment cuts in outpatient payment for many technologies like cryosurgery, Congress must pass legislation now allowing Medicare to use existing "outlier" funds for the pass-through program. CMS called for this change in early November. Specifically, legislation is needed to apply 25% of the 2 percent outlier pool to preventive services and 75% to reduce cuts in pass-through payments for new technologies. Over 15 patient and provider organizations spoke out in support of this change in a recent letter to Congress. In addition, this approach has been previously advanced by 27 House Members, the bipartisan leadership of the Ways and Means Committee, and a bipartisan group of 14 Senators. Use of outpatient outlier funds only would be required for 2002. After that, most new technologies covered under the pass-through program would be incorporated into base outpatient payment bundles. Quote of the week "We support the recommendation by CMS to use funds in the 'outlier' pool to further reduce payment cuts and maintain adequate reimbursement for important preventive services."
-- Letter to Congress signed by over 15 patient and provider organizations.
Last updated: 14-Dec-01
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