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    CMS Issues Final 2015 Rules for Inpatient Prospective Payment Systems

    The Centers for Medicare and Medicaid Services (CMS) has issued final rules for prospective payment systems for acute care and long term care hospitals whose net effect will be to decrease payments to acute care hospitals paid under the inpatient prospective payment system (IPPS) by $756 million and increase payment to long term care hospitals (LTCHs) by 1.1% under the LTCH prospective payment system.

    Despite a call for comments from stakeholders, the rule avoids making any final changes to the "2-midnight" policy or regarding policies for short stays. The rule also finalizes the use of 5 readmissions measures for assessing readmission penalties, incorporating methodology changes supported by APTA related to hip and knee arthroplasty.

    Among other changes set for 2015:

    • Hospitals in the top quartile for the rate of hospital acquired conditions (HACs)—those with the poorest performance—will have their Medicare IPPS payments reduced by 1%.
    • CMS will distribute $7.65 billion in uncompensated care payments, a decrease from the $8.56 billion estimate in the proposed rule.
    • CMS will assess hospitals’ readmission penalties using 5 readmissions measures endorsed by the National Qualify Forum (NQF): heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and hip/knee arthroplasty. CMS has finalized an updated methodology to take into account planned readmissions for these 5 existing readmissions measures, as well as refinement in the hip/knee arthroplasty readmission measure methodology.
    • CMS provides guidelines for implementing the Affordable Care Act's provision requiring transparency in hospital charges. Under these guidelines, hospitals should either publish a list of their standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.

    In addition to the changes for 2015, CMS finalized the addition of 2 quality measures related to function for the 2018 long term care hospital (LTCH) Quality Reporting Program. The measures, titled "Functional Outcome Measure: Change in Mobility among LTCH Patients Requiring Ventilator Support;" and "Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function," were supported by APTA.

    APTA participated in the comment period for the 2015 rules when they were proposed by CMS earlier this year, and will be publishing a summary of the changes online in the coming weeks.


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    Posted by Leo Robertson on 8/7/2014 10:21 AM
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