The Inpatient Prospective Payment System final rule increases payments to hospitals in the Inpatient Quality Reporting Program by 0.95% and reverses the proposed payment reduction instituted along with the two-midnight rule.
Payment rates will increase by 0.95% in FY 2017 compared to FY 2016 for hospitals participating in the Inpatient Quality Reporting (IQR) Program and meaningful EHR use, according to the rule.
"This also reflects a 1.5 percentage point reduction for documentation and coding required by the American Taxpayer Relief Act of 2012 and an increase of approximately 0.8 percentage points to remove the adjustment to offset the estimated costs of the two-midnight policy and address its effects in FYs 2014, 2015, and 2016," said CMS.
CMS made a permanent adjustment of approximately 0.2% to remove the cut for FYs 2017 and onward, and a temporary adjustment of 0.6% to address the retroactive impacts of this cut for FYs 2014, 2015 and 2016, CMS states.
CMS finalized five changes to the Hospital-Acquired Conditions Reduction Program in this rule, as well as updates to the IQR program, changes to the Hospital Readmissions Reduction Program, and updates to the Hospital Value-Based Purchasing Program.
Listening to commenter feedback, CMS reduced requirements for reporting electronic clinical quality measures (eCQM) as part of the IQR program. Originally, CMS proposed requiring hospitals to submit data on all 15 eCQMs, but finalized a policy requiring hospitals to report four quarters of data on an annual basis for eight of the available eCQMs.
As part of the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, CMS created the Medicare Outpatient Observation Notice (MOON).
The MOON is a CMS-developed standardized notice hospitals are required to give to Medicare patients receiving observation services as an outpatient for more than 24 hours no later than 36 hours after observation services are initiated. Hospitals must give a verbal explanation of the MOON to patients and obtain a signature to acknowledge receipt and understanding of the notice.
"The standardized notice, the MOON, is going through the Paperwork Reduction Act process, thus affording the public an opportunity to comment on the MOON. The 30-day public comment period begins when the final rule is published," said CMS.
The entirety of the final rule is available in PDF format on the Federal Register, and is expected to be officially published by CMS on Monday, August 22. CMS says the rule applies to approximately 3,330 acute care hospitals and approximately 430 long-term care hospitals, and will affect discharges occurring on or after October 1, 2016.
Pokémon Go, the most popular mobile game app ever in the U.S., has captured the attention of players of all ages. But it could also be capturing sensitive images and information in hospitals, which could lead to a violation of HIPAA privacy rules.
Employees at Massachusetts General Hospital received an email yesterday reminding them that Pokémon Go may not be used during work or on hospital property.
“The ability for smart phones (sic) to record images and location via the camera and GPS features pose a significant risk to patient privacy and safety,” wrote Steve Taranto, director of human resources, at Massachusetts General Hospital.
In the game, players are tasked with capturing Pokémon, and the game renders the creatures on top of live environments using the device’s camera.
The Department of Health & Human Services (HHS) offers many resources for providers pertaining to mobile device use in hospitals, including videos,FAQs, and downloadable materials.However, most of HHS’ material is aimed at offering guidance on protecting patient records and medical information by securing devices and encrypting data.
While the game could photograph patient records or other protected health information (PHI), simply capturing a patient’s name or face in the image could lead to a violation.
“Just taking a picture is not a violation,” says Chris Apgar, CISSP, CEO and president of Apgar & Associates in Portland, Oregon.
“It only becomes a violation if the photo is posted on social media without patient authorization received first,” he says. “If the employee loses the phone or the phone is stolen, that could become a breach of PHI, though, if the phone is not encrypted.”
Taking photos on hospital property could also be a violation of a facility’s device usage policy for employees.
The game has hospitals concerned for reasons beyond privacy, with several facilities in Utah asking players to be considerate of patient safety, and their own, with some gameplay locations situated near helipads, according to the Daily Herald.
Covenant Healthcare in Michigan, meanwhile, has warned players to avoid using the game on its property, noting the security department and local police have been alerted, according to MLive. Cookeville Regional Medical Center in Tennessee has likewise banned the game from its premises, reports the Herald Citizen, with officials noting that parking is already limited and entering the facility to play could be a safety and privacy risk.
"This proposal will be very challenging for hospitals that have community physicians practice at their off-campus outpatient departments that will no longer be paid under OPPS," says one expert.
CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule, released yesterday.
The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond.
Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services.
Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).
"This proposal will be very challenging for hospitals that have community physicians practice at their off-campus outpatient departments that will no longer be paid under OPPS," says Valerie Rinkle, MPA, lead regulatory specialist and instructor for HCPro, a division of BLR, in Middleton, Massachusetts.
"These physicians would bill with the office place of service code and the hospital would have to figure out how to get compensated," she says. "This will likely require hospitals to re-write their agreements with these physicians."
CMS' proposal for operationalizing Section 603 comes as somewhat of a surprise since the burden is being placed squarely on providers, with CMS' own systems not ready to allow existing billing practices, says Jugna Shah, MPH, president and founder of Nimitt Consulting, Inc.
"Some providers hoped CMS would delay implementation and others speculated that modifier –PO might get repurposed for CY 2017," says Shah. "Perhaps commenters will be able to offer CMS solutions that will minimize provider operational burden."
CMS writes in the proposed rule:
We intend the policy we are proposing in this proposed rule to be a temporary, 1-year solution until we can adapt our systems to accommodate payment to off-campus PBDs for the non-excepted items and services they furnish under the applicable payment system, other than OPPS.
CMS would allow certain excepted items and services to still be billed under the OPPS:
All items and services furnished in a dedicated emergency department
Items and services furnished in a hospital department within 250 yards of a remote location of the hospital and within 250 yards of the main hospital (i.e., on-campus)
Items and services that were furnished and billed by an off-campus PBD prior to November 2, 2015
Hospitals could also continue to bill for services at these facilities that are not paid under the OPPS, such as laboratory services.
Off-campus PBDs built and billing before November 2, 2015, would retain grandfathered status or what CMS calls "excepted" status and continue billing under the OPPS, but the proposed rule includes some caveats. While the agency proposes that a change in ownership would not change an off-campus PBD's excepted status as long as the new owner assumes the same provider agreement, a change in location would. However, CMS is requesting comments on this provision and whether certain exceptions should apply for situations beyond a hospital's control such as a natural disaster.
Off-campus PBDs that expand services beyond those offered and billed before November 2, 2015, will not be allowed to bill them under the OPPS. CMS has proposed clinical families based on APCs that would determine whether those expanded services would continue to be excepted (see Table 21 on page 342 of the proposed rule).
"The concept of tracking service expansion by APC will be extremely difficult to implement and operationalize," says Rinkle. "It would have been simpler for CMS to define this by revenue codes than APCs."
For more information, seeCMS' fact sheet. Comments are due by September 6 and a final rule is expected by November 1.
