Hospitals will receive slightly higher payments from Medicare this fall, provided they participate in the government’s quality reporting program.
Medicare payments are set to increase 2.8% in fiscal year 2013 to general acute care hospitals that successfully participate in Medicare’s Inpatient Quality Reporting Program. Those hospitals that don’t participate will get just a 0.8% bump in their payments, though Medicare officials estimate that nearly all hospitals participate.
Medicare payments to long-term care facilities will increase by 1.7% in the coming fiscal years, which starts Oct. 1, according to the Centers for Medicare and Medicaid Services.
The new payment rates were announced Aug. 1 as part of the final rule for the Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System.
In its original pay proposal published in May, the CMS said it would increase payments to general acute care hospitals by 2.3% because of cuts the agency was making to account for hospital coding that was too high.
Based on public comments in opposition to the coding adjustments, the CMS backed off the cuts for now. The American Hospital Association estimates that the initial proposal would have cost hospitals nationwide a total of $850 million.
The final rule also lays out the requirements and penalties of new quality programs that debut in October. Under the Hospital Readmissions Reduction Program, hospitals’ base operating DRG (diagnosis related group) )payment will be cut by 1% if their readmission rate for three conditions – acute myocardial infarction, heart failure, and pneumonia – is deemed too high. The agency estimates the program will reduce overall payments to hospitals by about $280 million in FY 2013.
For the Hospital Value-Based Purchasing (VBP) Program, which also begins on Oct. 1, the final rule specifies hospitals will receive their total performance scores, indicates how the 1% penalty will be applied to base operating charges, and provides the timeline for making incentive payments. New measures also were added to the program for FY 2015: a central line-associated bloodstream infection measure, a patient safety indicator composite measure, and an efficiency measure that looks at Medicare spending per beneficiary.
The CMS is revising its list of hospital-acquired conditions for which it will not pay. Starting this fall, surgical site infection following cardiac implantable electronic device procedures will make the do-not-pay list, along with iatrogenic pneumothorax with venous catheterization.
The agency also is adding two new codes to the list of hospital-acquired conditions: bloodstream infection due to central catheter (999.32) and local infection due to central venous catheter (999.33).
The final rule will be published in the Federal Register on Aug. 31 and will go into effect on Oct. 1.