LUGPA Comments to CMS Regarding Recent Outpatient Prospective Payment System (OPPS) Final Rule for 2017

Deepak A. Kapoor, MD
Deepak A. Kapoor, MD
Neal D. Shore, MD
Neal D. Shore, MD

LUGPA recently commented to Centers for Medicare and Medicaid Services (CMS) regarding its recent Outpatient Prospective Payment System (OPPS) Final Rule for 2017.


LUGPA’s comments focus on CMS’s implementation of Section 603 of the Bipartisan Budget Act of 2015 (“BBA”). This law mandates that an off-campus provider-based department (“PBD”) will no longer be reimbursed under the OPPS, but instead under another “applicable payment system,” unless the PBD was in operation prior to November 2, 2015. As CMS recognized in the OPPS Proposed Rule issued in July, Section 603 “is intended to curb the practice of hospital acquisition of physician practices that then result in receiving additional Medicare payment for similar services.”

LUGPA commends CMS for finalizing many provisions of the Proposed Rule in a manner that reflects Congress’s important site-neutrality goals. Unfortunately, in certain important respects, the Final Rule creates interim policy that appears to contradict the language and purpose of Section 603 of the BBA. Without certain revisions, we believe that “the exceptions will swallow the rule” and CMS will have failed to implement a site-neutral payment structure as Congress directed.  We are particularly concerned with the following:

  • The Final Rule appears to remove all limitations on the services for which an “excepted PBD” may bill under the OPPS-even if these services are entirely different from the types of services the PBD provided prior to November 2, 2015; and
  • The Final Rule creates a new payment system for “non-excepted PBDs” that will perpetuate the dramatic payment disparity Congress sought to remedy in Section 603 of the BBA. The data we present in this comment letter shows that, if left unchecked, this payment disparity could approach half a billion dollars annually with respect to commonly performed urologic services alone.

LUGPA believes that the creation of a truly site neutral reimbursement for each CPT Code is the only way to achieve Congress’s goal of curbing the practice of hospital acquisition of physician practices; a practice that results in additional out-of-pocket costs for Medicare beneficiaries and greater expenses for the healthcare system as a whole.

LUGPA ‘s formal request for action provides CMS specifics regarding how the interim rule could be modified so that  the  Medicare Physician Fee Schedule (which governs non-facility reimbursement) can be effectively implemented in non-excepted PBDs.

Thank you to all LUGPA members for your continued support of our health policy advocacy efforts. LUGPA will maintain its dedication to be the voice of independent urology practices.

Respectfully submitted,

Neal D. Shore, MD, FACS


Deepak A. Kapoor, MD
Chair, Health Policy and Government Relations