Highlights of the 2024 Outpatient Prospective Payment System (OPPS)

August 29, 2023
Medicare Advantage Plans

On July 13, 2023, CMS issued proposed rules for the 2024 Physician Fee Schedule (PFS) and the Hospital Outpatient Prospective Payment System (OPPS). Comments for both are due on September 11, 2023, by 5 pm Eastern.

You should read the documents yourself, but here are some highlights of the 2024 OPPS proposed rule (in no particular order):

  • A 2.8% payment increase for eligible hospitals.
  • A statutory 2.0% point reduction in payments for hospitals that fail to meet the hospital outpatient quality reporting requirements by applying a reporting factor of 0.9805 to the OPPS payments and copayments for all applicable services.
  • Seeking stakeholder feedback on telehealth as potential future measurement topic areas in the Hospital OQR Program.
  • CMS is seeking comments on the proposed CY 2024 status indicators and APC assignments for the new and revised CPT codes that will be effective January 1, 2024.
  • Modification of certain aspects of the hospital price transparency requirements which will require hospitals to display standard charges using a CMS template format.
  • Requirement in the Physician Fee Schedule re: discarded amounts of certain single dose or single use packaged drugs which is being cross referenced in this rule as the same requirements would apply in the hospital outpatient setting.

Adoption of new quality measures – one of possible interest is the proposed HOPD Procedure: Volume Measure which would collect data regarding the aggregate count of selected surgical procedures including skin. CMS would collect data surrounding the top 5 most frequently performed procedures among HOPDs in each category and publicly display them. The top 5 would also be assessed and updated annually to ensure data collection is accurate and frequently performed procedures. – HOPDS would report all patient volume data.

Caroline Fife, MD

Dr. Fife is Co-Founder and Chief Medical Officer of Intellicure, Executive Director of the US Wound Registry, and Editor of Today’s Wound Clinic.

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