Health Care Policy Update: CMS releases proposed CY2027 HOPD and ASC payment regulation

Research evidence excerpt

Health Care Policy Update: CMS releases proposed CY2027 HOPD and ASC payment regulation

CMS releases its proposed 2027 Medicare Hospital

Outpatient PPS and ASC payment regulation

On July 2, Centers for Medicare & Medicaid Services (CMS) released its proposed 2027

Medicare Hospital Outpatient Prospective Payment System (HOPPS) regulation, as well

as the ASC payment update. Overall, CMS estimates a net +1.8% increase in hospital

outpatient payments for 2027. The regulation includes a hospital market basket update

of 3.2%, less a 0.8% productivity reduction, yielding a 2.4% update. CMS also includes -

0.4% additional adjustment for reduced payments for off-campus providers for imaging

services w/o contrast. Along with other adjustments (wage index outlier adjustments,

and revised pass-through payments), resulting in a net increase of +2.5% for hospitals.

In addition, CMS proposes a -3.0% reduction for the 340B Remedy Offset (for non-drug

items and services), this is an increase from the -0.5% reduction CMS included in 2026.

CMS projects total hospital outpatient payments to increase by $1.8 billion in 2027 from

changes in the regulation, while the 340B remedy reduces Medicare spending by $2.3

billion in 2027. CMS estimates overall hospital-based outpatient department (HOPD)

Medicare payments will increase by $9.5 billion, to $110.9 billion, when enrollment,

utilization and case-mix are included. Urban hospitals expect to see a net 1.3% increase

in outpatient payments (before 3.0% 340B remedy offset), while rural hospitals would

see a 5.9% increase (before 340B offset). For-profit hospitals are projected to see a

much larger +10.3% increase in payments (before the 340B remedy offset).

Overall, hospital Outpatient Payments for 2027 are worse than expected as