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Meaningful Health Care Informatics Blog

Apr 29 2012   9:31PM GMT

Medicare Proposed Payment Rule FY 2013

Posted by: RedaChouffani
ACA, Affordable Care Act, CMS, FY 2013, IPPS, LTCH, payment rule

On April 24, 2012 CMS issued a proposed rule for the updated payment policy and rates for inpatients stays to general acute care hospitals paid under the hospital inpatient prospective payment system and long-term care hospital PPS (IPPS and LTCH) proposed rule for fiscal year 2013.

“The proposed rule would implement key elements of the Affordable Care Act’s value-based purchasing program as well as the hospital readmissions reduction program. It also establishes the groundwork for extending Medicare’s quality reporting programs beyond general acute care hospitals to other types of facilities,” said CMS Acting Administrator Marilyn Tavenner.  “It is part of a comprehensive strategy to use Medicare’s payment systems to foster better care and better value in all settings, thereby reducing overall Medicare spending.”

The current increase in payment rates is projected to be 2.3 percent in FY 2013.  It has also been projected by CMS that the increase in payment rate and some of the projected utilization will increase Medicare’s operating payments by 0.9 percent in FY 2013.

The proposed ruling includes new outcome measures that will reward hospitals that avoid healthcare-associated infections (HAI) from central line-associated bloodstream infection.  CMS is also proposed to include measures for perinatal care and readmission, including overall readmissions and readmissions relating to hip and knee replacements procedures, and for the use of surgery checklists.

In addition CMS is proposing to add a new survey to measure the HCAHPS measures to assess the quality of patients’ care transition.

Following are some of the proposed ruling additions:

  • A one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an on-going research initiative to re-define the role of LTCHs in the Medicare program.
  • To apply an approximate 1.3 percent reduction (first year of a proposed three-year phase-in) for a one-time prospective budget neutrality adjustment.  The proposed reduction would not apply to discharges occurring on or before December 28, 2012, because the law prohibits its application before that date.  The budget neutrality adjustment reduces the update from 2.1 percent to 0.8 percent.
  • To reduce Medicare payments for very short stay cases in LTCHs to the IPPS comparable per diem amount payment option for discharges occurring on or after December 29, 2012.  The law prohibits application of this policy prior to that date

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