ASHP Offers Tips for Surviving New CMS Part B Payment Regulation

3/20/2009

Pharmacy departments should take immediate steps to minimize the impact of lower reimbursement rates under the Medicare Hospital Outpatient Prospective Payment System (HOPPS), according to an ASHP Advisory released this week by ASHP.

The Advisory was authored by Bonnie Kirschenbaum, MS, FASHP, FCSHP, and made possible by ASHP’s enhanced advocacy program.

The Advisory examines the effects of changes to the Medicare HOPPS, and offers strategies for pharmacy departments to comply with the new regulation. The regulation, which took effect January 1, 2009, lowers the reimbursement rate for medications covered under Medicare Part B to average sales price (ASP) plus four percent.

The Advisory recommends that pharmacy departments:

• Meet with the hospital financial team to develop a strategy for coping with the changes.
• Assess the impact of the reduction in reimbursement for Part B medications, as well as pass through payments and IVIG pre-administration fees, and
• Partner with nursing to agree on any procedural changes needed for 2009.

ASHP, along with other stakeholders, has argued that CMS’s reimbursement strategy does not adequately cover pharmacy overhead costs and urged CMS to revisit its reimbursement model. Last month, ASHP made a similar recommendation in testimony to the CMS Advisory Panel on Ambulatory Payment Classification Groups.

Click here to read the paper.