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  • Push for More Data Reiterated in Proposed CMS Rule on Inpatient Payment

    The recently released proposed rules for inpatient prospective payment systems (IPPS) continues the US Centers for Medicare and Medicaid's (CMS) push for more data from facilities, with some payment increases being contingent on quality reporting participation and meaningful use of electronic health records (EHRs).

    The rule sets out a 1.1% increase in operating payment rates for acute care hospitals that successfully participate in the hospital inpatient quality reporting program (IQR) and that are "meaningful" users of EHRs. Hospitals that don't meet the IQR requirements could see a one-fourth reduction in payment rates, and hospitals that fail to achieve meaningful EHR use by 2016 would face a cut of one-half of any update issued.

    Other features of the proposed rule:

    • Overall, long-term care hospitals (LTCH) could see a 4.6% decrease in payments, mostly because of the introduction of a 2-track system that will use the standard LTCH prospective payment system for patients who meet certain clinical criteria, and apply lower "site neutral" rates—based on the IPPS—to patients who don't meet the criteria. Cases that do qualify for the standard LTCH prospective payment system rate will get an increase of 1.9%. The 2-track system was mandated by a law passed in 2013.
    • CMS would introduce additional measures required of hospitals. Outcomes being evaluated include care coordination beginning in 2018, and 30-day mortality rates for chronic obstructive pulmonary disease in 2021. Additionally, the agency would expand the range of data collected around hospital-acquired conditions.
    • LTCHs would be required to supply reports on pressure ulcers and falls as part of a CMS effort to implement the IMPACT Act, a 2014 law that strengthens and standardizes the collection of data on postacute care.

    The proposed rule also seeks feedback on a CMS bundled payment initiative that links payments for multiple services during 1 episode of care into a combined payment. The initiative is testing 4 models of bundling, and CMS is asking for comments on future expansion of the plan.

    APTA has produced a summary of the proposed rule (.pdf), and will provide comments to CMS on behalf of its membership.

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