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  • Inpatient Payment Proposed Rule Calls for $3 Billion Increase to Acute Care Hospitals, Reductions for Long-Term Care Hospitals

    In brief:

    • Acute care hospitals are slated for 2.9% payment increases (approximately $3 billion) in 2018
    • Long-term care hospitals (LTCHs) could see a 3.75% reduction
    • EHR-related incentive programs would ease some quality-reporting requirements
    • Rule would institute a 1-year moratorium on 25% threshold policy for LTCHs
    • Patient satisfaction survey questions on pain would return in reworded form

    Acute care hospitals (ACHs) could receive a 2.9% increase in payment rates next year and see a relaxation in some reporting requirements related to electronic health records (EHRs) if a proposed rule from the Centers for Medicare and Medicaid Services (CMS) is rolled out as-is. The losers in the equation? Long-term care hospitals (LTCHs), which could face a 3.75% payment cut under the proposal.

    The inpatient prospective payment system (IPPS) proposed rule released last week (CMS fact sheet here) covers a range of areas related to how ACHs and LTCHs would operate in relation to Medicare and Medicaid beneficiaries. Here are a few highlights of the proposed rule:

    • The proposed 2.9% ACH payment increase amounts to a $3 billion increase. Last year the increase was 0.95%.
    • CMS plans to back off on quality-measure reporting requirements for hospitals involved in Medicare and Medicaid EHR incentive programs. Under the proposed rule, CMS would decrease both the number of times participating hospitals need to report, as well as the number of quality measures they include in the reports.
    • In addition to the 3.75% payment reduction, LTCHs would also receive a 1-year moratorium on a policy that applies to LTCHs that admit more than 25% of their patients from a single acute care hospital. Under the current policy, payments for all patients over that 25% threshold are made at a rate comparable to an ACH. The proposed rule would suspend that threshold for a year.
    • After suspending consumer survey questions on pain management that some stakeholders felt may have been working at cross-purposes to efforts to fight the opioid epidemic, CMS is proposing reinstating reworded questions to focus on the hospital's communications with patients about their pain during their stay.
    • The proposed rule also calls for comments on whether CMS should account for social risk factors in a range of programs that touch on readmissions, value-based purchasing, hospital-acquired conditions, and quality reporting.

    APTA will prepare comments on the proposed rule in time for the June 13 submission deadline.

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