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2015 IPPS Proposed Rules Detailed

Michelle A. Leppert, CPC, May 1, 2014

Hospital-acquired Conditions

CMS is proposing to reduce payments for hospitals with the highest rate of HACs by 1% to comply with the Patient Protection and Affordable Care Act. The reduction will apply to the bottom 25% of hospitals (i.e., those with the worst HAC rates).

CMS is not planning to add or remove any HAC categories from the current list, but did ask for continued public comments.

Readmissions Reduction

In addition, CMS proposes increasing the maximum payment reduction for hospital readmissions from 2% to 3%, also to comply with the ACA. CMS proposes to assess hospitals' readmissions penalties using five readmissions measures endorsed by the National Quality Forum.

Under that program, CMS defines a "readmission" as an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital.

Value-based Purchasing

The ACA created VSP, which adjusts payments to hospitals under the IPPS based on the quality of care they deliver to patients, in 2013. VBP incentives are funded by a reduction in base-operating DRG payments. The base-operating DRG includes the wage-adjusted DRG operating payment as well as any new technology add-on payments.

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