New 2015 HOPPS ruling cuts into PET payments
The Centers for Medicare & Medicaid Services (CMS) issued final rules for the 2015 Hospital Outpatient Prospective Payment System (HOPPS) and the Medicare Physician Fee Schedule (MPFS). The rules were recorded in the Federal Register Nov. 10 and go into effect Jan. 1, 2015. It appears that changes to HOPPS will depress PET payments by 1.9 percent.
Even though the HOPPS conversion factor for 2015 has been increased 2.2 percent to $74.144, CMS is subjecting hospitals to certain quality measures that, if not satisfied, will result in a 2 percent reduction in the conversion factor to $72.661.
IBA Molecular today provided radiopharmaceutical stakeholders with a breakdown of the financial impact of the recent ruling and noted that HOPPS payments for PET procedures are set to undergo a decrease of 1.9 percent in 2015. Most procedures involving PET, including whole-body PET, myocardial perfusion imaging, brain PET and whole-body PET/CT will be paid at the level of $1,285.72 in 2015, vs. the $1,310.60 that has been paid in 2014.
Excluding diagnostic radiopharmaceuticals with pass-through status, all payments for diagnostic agents will be packaged as usual, including drugs used in myocardial stress tests. Therapeutic radionuclide drugs will be paid separately based on average sales price plus 6 percent.
The MPFS is not expected to change the current pay scale for PET, but U.S. Congress will have to intervene before April of next year or nuclear medicine procedures will suffer a 21.2 percent loss in payments due to a drop in the conversion factor from $35.80 to $28.22, according to the IBA report.
The new HOPPS and MPFS rules were first announced Oct. 31, at which time a comment period was initiated that continues until Dec. 30.