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IPPS Proposed Rule Adds Readmission Measures, HAC Timeline

Cheryl Clark, for HealthLeaders Media, April 29, 2013

New definition of an admission
The agency is redefining or clarifying the definition of an inpatient admission as that which spans at least two midnights, an effort to clarify policies that have pushed hospitals to classify patients not as inpatients, but as on "observation status."

If a patient is in the hospital for a shorter period, "will presumptively be inappropriate for payment under Medicare Part A," the agency said in a news release.

This presumption may be overcome, however, if the medical record documentation supports a physician's "expectation that the beneficiary would need care spanning at least two midnights" but unforeseen circumstances shortened that duration.

"This proposed policy would address longstanding concerns from hospitals that they need more guidance on when a patient is appropriately treated and paid by Medicare as an inpatient" and would " help beneficiaries who in recent years have been having longer stays as outpatients because of hospital uncertainties about payment if they admit the patient to the hospital," the media release states.

Late Friday, the American Hospital Association issued a statement saying that said it is "pleased" that CMS "used its discretion to dampen" the impact of the sequester, so that hospitals will still receive higher payment rates in FY 2014. "We continue to believe that these excessive cuts are not warranted; however, CMS' proposal has provided hospitals with additional time to manage enormous changes to patient care delivery."  

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