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CHA DataSuite Issues Summary Analysis of Calendar Year 2020 Outpatient PPS Proposed Rule

For CFOs

CHA DataSuite has issued a hospital-specific analysis detailing the Centers for Medicare & Medicaid Services (CMS) calendar year (CY) 2020 outpatient prospective payment system (OPPS) proposed rule. The analysis is intended to show providers how Medicare outpatient fee-for-service payments may change from CY 2019 to CY 2020 based on the policies set forth in the CY 2020 OPPS proposed rule, using the FFY 2020 inpatient prospective payment system final rule wage index.

The analysis incorporates the following changes to outpatient payments mandated by Congress and implemented by CMS:

  • Market basket update
  • Affordable Care Act-mandated market basket reductions
  • Pass-through spending and outlier budget-neutrality adjustment
  • Updated wage index values
  • Reduction in wage index disparities
  • Other ambulatory payment classification factor updates

In addition, the analysis models the estimated impact of two other CMS changes that are calculated separately (if applicable):

  • Estimated impact of 30% reduction to excepted off-campus provider-based departments
  • Potential impact of performing total hip arthroplasty procedures in an outpatient setting, using CPT code 27130

For more information, see the analysis description.