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May 1—Hospitals would receive a 1.3 percent Medicare increase in FY15 under a proposed payment rule issued late Wednesday by the Centers for Medicare & Medicaid Services (CMS). CMS also requested suggestions on an alternate payment methodology for short-stay admissions.
CMS’s hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) proposed rule for FY15 would provide the 1.3 percent increase after accounting for inflation and other statutorily required adjustments. The initial 2.7 percent market-basket update for hospitals that submit data on quality measures and were meaningful users of electronic health records in FY13 would be reduced by one-quarter for hospitals that do not undertake either initiative. Hospitals that fail to meet the requirements of both initiatives would lose half of the initial market-basket rate.
All IPPS hospitals would receive a productivity cut of 0.4 percent and an additional market basket cut of 0.2 percent, as required by the Affordable Care Act (ACA). Another 0.8 percent cut that would, in part, fulfill the requirement of the American Taxpayer Relief Act of 2012 (ATRA) that CMS recoup supposed surplus payments from FY10-FY12.
Another cut included in the rule was the latest 1 percent ACA-mandated reduction in Medicare disproportionate share hospital payments.
All proposed FY15 changes would reduce the overall rate to 0.8 percent, a Bank of America-Merrill Lynch analysis noted. That cut was in line with the analysts’ expectations, although it is expected to hit urban hospitals worse with a 0.9 percent cut than rural hospitals, which face a 0.2 percent overall cut.
Also included in the rule was a request for suggested an alternative payment methodology under the Medicare program for short inpatient hospital stays.
“We are interested in public comments on such a payment methodology, specifically how it might be designed,” the proposed rule stated. “There are several issues of consideration that would inform how such a payment methodology would be devised.”
Among the specific questions and considerations that CMS identified as critical for developing an alternative payment methodology was how to define short-term or low-cost hospital stays.
“While HFMA appreciates CMS’s request for feedback on a new short-stay payment policy, we are deeply concerned with the proposed average 0.8 percent reduction in payments included in the proposed rule,” said Chad Mulvany, director, healthcare finance policy, strategy and development for HFMA. “Among other items, HFMA remains concerned that the proposed reduction to DSH payments is greater than statutorily warranted based on coverage expansion.”
The request for input on an alternative payment methodology for short-stay admissions followed recent legislation delaying full enforcement of a new short-term admissions policy by six months—until April 2015—which came amid hospital concerns about numerous uncertainties surrounding details of its implementation.
The lack of significant changes in the two-midnight policy drew criticism from some hospital advocates.
“CMS makes no concrete proposals and provides no indication that it will imminently abandon its flawed policy in favor of a new, more equitable approach,” said Blair Childs, senior vice president, Premier, an alliance of more than 2,900 U.S. hospitals and other providers. “This leaves hospitals trying to implement an unclear, unfair policy where they will soon be subject to audits.”
Other hospital advocates were pleased that the 0.8 percent ATRA cut was not larger.
“While we continue to be concerned about excessive coding cuts, today’s proposal to continue to phase in the coding cuts mandated by the [ATRA] will help provide hospitals with additional time to manage the payment reductions,” said Rick Pollack, vice president for the American Hospital Association.
For LTCHs, CMS proposed to increase payments by 0.8 percent in FY15 and proposed regulatory changes related to interrupted stays and co-located LTCHs, addressed statutorily required changes related to the so-called 25 percent rule and a moratorium on new LTCH facilities and beds, and discussed changes that coming in FY16 related to a new site-neutral payment system mandated by Congress.
The proposed rule will be published in the May 15 Federal Register, and comments will be accepted through June 30.
Publication Date: Thursday, May 01, 2014
Tom Myers, chief strategy officer, The SSI Group, discusses the shifting payment environment and how it affects providers' patient access and claims management processes.
Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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