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  • Final Inpatient Payment Rule Increases ACH Payments by $2.4 Billion, Cuts LTCH Payments by $110 million

    In brief:

    • Final rule from CMS increases acute care hospital payment by an estimated $2.4 billion, less than the $3.1 billion in the proposed rule
    • Long-term care hospitals (LTCHs) will see payments drop, but by less than proposed—a $110 million cut in the final rule, compared with proposed cut of $171 million
    • LTCH quality-reporting requirements related to skin ulcers will change; requirements will also include information on ventilator weaning
    • Final rule institutes a 1-year moratorium on 25% threshold policy for LTCHs
    • Patient satisfaction survey questions on pain will focus on communication about pain, not pain management

    Acute care hospitals (ACHs) will receive a $2.4 billion increase in payment rates in 2018 and see a relaxation in some reporting requirements related to electronic health records (EHRs) under the final prospective payment system (PPS) rule issued by the Centers for Medicare and Medicaid Services (CMS) on August 2. The long-term care hospital (LTCH) situation isn't as positive, however, with a projected 2.4% cut on the books for fiscal year (FY) 2018.

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

    • The ACH payment increase amounts to a $2.4 billion increase, less than the $3.1 billion in the proposed rule, but about 3 times the increase in FY 2017 ($746 million).
    • As in the proposed rule, the final rule sees CMS backing off on quality-measure reporting requirements for hospitals involved in Medicare and Medicaid EHR incentive programs. Participating hospitals can anticipate a drop in 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 2.4% payment reduction, LTCHs also will have 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 final rule suspends that threshold for a year.
    • The LTCH quality-reporting program will move toward updated pressure ulcer measures and will include additional measures related to ventilator weaning—but not until FY 2020.
    • 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 will reinstate 3 questions related to pain, but the new questions will be focused on communication about pain rather than pain management.

    The new rule will take effect October 1, 2017. APTA regulatory affairs staff members are reviewing the final rule and will publish highlights in the coming weeks. PT in Motion News will share links to those highlights when they become available.