Under a proposed rule for 2011 Medicare payments for hospital outpatient services, the Centers for Medicare and Medicaid Services (CMS) has proposed small increases and in some instances modest decreases in payments for most blood products. (See http://www.ofr.gov/OFRUpload/OFRData/2010-16448_PI.pdf.)   Payment for leukocyte reduced RBCs would increase from $186.73 in 2010 to $189.06 in 2011, while payment for platelets, pheresis would fall from the current rate of $469.11 to $448.96 in 2011.  Proposed payments for laboratory bone marrow/stem cell processing codes modestly increase, but still lag notably below the actual costs of these services.  Comments on the proposed rule are due to CMS by August 31, 2010 and the payments and other provisions of the final rule will become effective January 1, 2011. 

Overall, CMS is proposing an outpatient prospective payment system overall payment update of 2.15 percent for 2011.  Only those hospitals that successfully reported CMS-designated quality measures in 2010 will be entitled to the full 2.15 percent update.  If a hospital did not successfully report the quality measures, its update will be 0.15 percent.

Payments for Blood Products 

CMS has proposed to continue to establish payment rates for blood and blood products using the blood-specific cost-to-charge ratios from the most recently available hospital cost reports.  The following table compares the proposed 2011 payment rates for blood products with current Medicare payment rates: 

Payments for Blood Components

Payments for Bone Marrow and Stem Cell Processing Services

At its February 2010 meeting, the Ambulatory Payment Classification (APC) Advisory Panel recommended that CMS consider creating a composite APC or custom APC that captures the costs of stem cell acquisition performed in conjunction with recipient transplantation and preparation of tissue.  CMS has indicated that it will consider the advisory panel’s recommendation and will report the results of their assessment to the panel at a future meeting. 

CMS has proposed very modest increases in payments for bone marrow/stem cell processing codes 38207-38215, which were first recognized by the agency in 2008. The proposed payment rate for Codes 38207-38209 (cryopreservation and thawing codes) is $232.84 (compared with $227.89 now), and the proposed payment for Codes 38210-38215 (cell depletion codes) is $401.21 (compared with $390.10). It should be noted that since these payments are based on 2009 claims data, any more recent adjustments that hospitals have made in their charging practices are not yet reflected in CMS’ payments.  Hospitals are encouraged to take steps to ensure that their charges accurately reflect the actual costs of providing these services since CMS will base future payments on such charge data. 

The following table compares 2010 payment rates for transfusion and cellular therapy procedures with CMS’ proposed 2011 payments for these services:  

 Payments for Procedural Codes  

Supervision Requirements

Over the last several years, CMS has attempted to clarify Medicare policy regarding physician supervision of services performed in the hospital outpatient department.  In the final outpatient rule for 2010, CMS required direct supervision for all therapeutic services and defined direct supervision as requiring a physician or non-physician practitioner to be present on the same campus and immediately available to furnish assistance and direction throughout the performance of the procedure.   While CMS did not view this as a change in current policy, hospitals – particularly small rural hospitals and critical access hospitals – raised concerns that physicians were not always available when therapeutic services were provided, particularly in the case of services of long duration such as blood transfusions and very lengthy infusions.  

In response to these concerns, CMS has identified a limited set of non-surgical services requiring direct supervision for the initiation of the service only, after which general supervision will be sufficient.  (A service provided under general supervision is furnished under the overall direction and control of the physician, but his or her physical presence is not required during the performance of the procedure.)

CMS’ list of services, referred to as “non-surgical extended duration therapeutic services,” includes services with a lengthy monitoring component that typically have a low risk of complication after an assessment is made at the beginning of the service.  The list consists of a limited number of injection and infusion codes and two observation care services.  Because of quality concerns, CMS considered and rejected a proposal to offer hospitals the flexibility to broaden the list to include chemotherapy and blood transfusions, which some stakeholders also maintain do not require direct supervision.

AABB will submit comments to CMS regarding the proposed rule.