The Centers for Medicare & Medicaid Services' Inpatient Prospective Payment System final rule for FY 2015 includes a 1.4% increase for operating payment rates.
Hospitals learned late Monday the precise rules for how they will be paid for care provided to Medicare beneficiaries in the fiscal year starting Oct. 1, including guidelines for three penalties for poor quality performers.
The Centers for Medicare & Medicaid Services' Inpatient Prospective Payment System final rule for FY 2015 includes a 1.4% increase for operating payment rates. This factors in a market basket update of 2.9%, offset by -.5% percentage point productivity adjustment and a -.2 percentage point decrease as specified by the Patient Protection and Affordable Care Act, and a -.8% decrease in accordance with the American Taxpayer Relief Act of 2012.
In a news release, however, CMS tempered that amount saying that the 1.4% increase combined with the hospital readmissions reduction program whose penalties rise to the maximum of 3%, changes to payments for disproportionate share hospitals, and the expiration of other temporary increases "will decrease IPPS operating payments by approximately .6%."
Other highlights of the 2,442-page rule include the following:
Hospital-Acquired Condition Reduction Program
Hospitals that rank in the lowest performing quartile of certain adverse events will receive a 1% payment reduction. "These HACs are a group of reasonably-preventable conditions selected by CMS that patients did not have upon admission to a hospital, but which developed during their hospital stay."
The score, which is based on a risk-adjustment algorithm, includes two domains, one of which includes pressure ulcers, pneumothorax, central venous catheter-related bloodstream infections, postoperative hip fracture, postoperative pulmonary embolism or deep-vein thrombosis, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. The second domain includes central line associated bloodstream infections and catheter-associated urinary tract infections.
Readmissions Reduction Program
The maximum penalty for hospitals with higher-than-expected rates of readmissions rises from 2% in FY 2014 to 3% in FY 2015.
The five measures in the equation include 30-day unplanned readmissions of patients with
- Heart attack
- Heart failure
- Pneumonia
- Hip or knee surgery
- Hospital discharge for any reason
Price Transparency
Under the final rule, hospitals are to either make public a list of their standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.
CMS encourages hospitals to "engage in consumer-friendly communication of their charges to help patients understand what their potential financial liability might before services they obtain at the hospital" to enable price comparisons.
Disproportionate Share hospitals
Hospitals with this designation will receive 25% of the amount they would have received under the former formula. The remaining 75% "will be aggregated nationally and adjusted for decrease in the rate of uninsured individuals and a statutory factor of.2% and distributed to hospitals based on their relative share of the total amount of uncompensated care."
Hospital Inpatient Quality Reporting Program
The final rule spells out 57 reporting measures for FY 2016 and 63 for FY 2017. They include chart-abstracted measures such as heart attack and surgical care improvement, claims based measures such as mortality and readmissions, healthcare-associated infections, patient experience measures, and structural measures that evaluate a hospital's ability to improve quality.
Hospital Value-Based Purchasing Program
Hospitals will contribute $1.4 billion for the value-based purchasing pool, or 1.5% of base operating DRG payments. The money will be redistributed based on quality measures but excluding six clinical process measures that have topped out.
More than 80% of the measures in the program assess health outcomes such as 30-day mortality, patient experience and cost, such as efficiency. Two new measures are added, including hospital-onset methicillin-resistant staphylococcus aureus bacteremia and Clostridium difficile infection; and a clinical process measure, the rate of early elective deliveries.
Organ Transplant Centers
Transplant centers that have not met CMS's requirements for
data submission, clinical experience, or outcome requirements, or other conditions of participation, may be allowed to continue receiving Medicare payment if they can document mitigating factors after submitting formal requests for review.
CMS has issued a fact sheet on policy and payment changes and a fact sheet on improving quality of care during inpatient stays.