The Centers for Medicare & Medicaid Services (CMS) released its 2019 Hospital Outpatient Prospective Payment System (HOPPS) final rule. An initial evaluation of the rule found that CMS finalized provisions cutting Medicare reimbursement for certain visits to hospital outpatient clinics and to extend 2018 cuts to the 340B Drug Pricing Program.  

Under HOPPS, starting January 1, CMS will reimburse certain visits to hospital-affiliated off-campus providers at the lower Medicare Physician Fee Schedule reimbursement rate at which non-hospital affiliated providers are paid. Furthermore, the 2018 cut to the 340B Drug Pricing Program—which took reimbursement for eligible Medicare Part B drugs from Average Sales Price (ASP) +6 percent to ASP -22.5 percent—will be applied to previously exempt off-campus, provider-based hospital-affiliated clinics.

In comments on the proposed rule, ASCO urged CMS to not finalize any proposals that would reduce payments for Part B drugs purchased through the 340B drug pricing program or based on site-of-service. ASCO opposes any cuts to resources for cancer care delivery determined merely by picking the lowest cost among treatment settings, as such cuts could diminish patient access to needed cancer care services.

ASCO is assessing the full impact of the 2019 HOPPS final rule on the oncology community and will continue to work with CMS to develop appropriate reimbursement policies for cancer care services—starting with submitting feedback on the final rule during its open comment period.

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