HAP Resource Center

Advocacy Correspondence: HAP Comments to CMS, CMS–1793–P, Medicare Program; Hospital Outpatient Prospective Payment System

September 11, 2023

The Honorable Chiquita Brooks-LaSure
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
Attention: CMS–1793–P
P.O. Box 8016
Baltimore, MD  21244-8016

RE: CMS–1793–P, Medicare Program; Hospital Outpatient Prospective Payment System

Dear Administrator Brooks-LaSure:

On behalf of The Hospital and Healthsystem Association of Pennsylvania (HAP), representing more than 230 hospitals and health systems statewide, we appreciate the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) hospital outpatient prospective payment system proposed rule for calendar year (CY) 2024.

For CY 2024, CMS proposes a market basket update of 3.0 percent less a productivity adjustment of 0.2 percentage points, resulting in a net update of 2.8 percent. This is simply not enough. HAP is greatly concerned about this inadequate update, especially when taken together with the underwhelming market basket increases from CY 2022 and 2023. It does not capture either the unprecedented inflationary environment or the other persistent financial headwinds hospitals and health systems are experiencing. It also fails to account for the fact that labor composition and costs have remained extraordinarily high and that, as a result, the hospital field has continued to face sustained financial pressures and workforce shortages.

Given all the above, HAP strongly urges CMS to find ways to account for these increased costs to ensure that beneficiaries continue to have access to quality outpatient care. We also urge the agency to reduce the productivity cut for CY 2024 as such a cut does not align with hospital and health systems’ public health emergency experiences related to actual losses in productivity during the COVID-19 pandemic.

Additionally, CMS is proposing several changes to the hospital price transparency requirements related to standardization of and changes to CMS’ monitoring and enforcement processes, and requests comment on how to better align the various price transparency policies going forward. HAP encourages CMS to work closely with the American Hospital Association (AHA) to improve the hospital price transparency rule, especially as it relates to better aligning these requirements with the Transparency in Coverage and No Surprises Act requirements.

We also reiterate our position against continuing site-neutral payment reductions. CMS should reverse its unlawful and harmful policy reducing payment for outpatient clinic visits in excepted provider-based hospital outpatient departments.

In addition, we incorporate, by reference, all of the comments provided in the AHA’s response to the proposed rule.

Thank you for your consideration of HAP’s comments about this proposed rule regarding outpatient payment and other provisions related to hospitals and the patients they serve in Pennsylvania.

If you have any questions, contact Kate Slatt, vice president, innovative payment and care delivery, at (717) 561-5317.



Jeffrey Bechtel
Senior Vice President, Health Economics and Policy




Topics: Affordable Prescription Drugs, Behavioral Health, Billing/Transparency, Federal Advocacy, Medicare

Revision Date: 9/11/2023

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