CMS issued a rule yesterday that will update Medicare payment policies and rates for inpatient stays in acute-care hospitals under the Inpatient Prospective Payment System and hospitals paid under the Long-Term Care Hospitals Prospective Payment System in fiscal year 2013.
In addition to payment updates for inpatient services to Medicare beneficiaries, the rule includes several important changes to federal quality reporting programs:
Hospital inpatient quality reporting program
1. The final rule reduces the number of measures in the inpatient quality reporting program from 72 to 59 for the FY 2015 payment determination and 60 for the FY 2016 payment determination.
2. CMS is reducing the annual random validation sample from 800 hospitals to 400 hospitals. CMS is also reducing the targeted sample to up to 200 hospitals by using specific targeting criteria.
New quality reporting programs
3. CMS has created new quality reporting programs for two types of hospitals that are exempt from payment under the IPPS — inpatient psychiatric facilities and cancer hospitals.
4. CMS finalized an initial set of five quality measures and program requirements for reporting in FY 2013 by cancer hospitals and an initial set of six "process of care" measures for reporting in FY 2013 for inpatient psychiatric facilities.
Hospital value-based purchasing program
5. The IPPS final rule also establishes several operational policies for FY 2013, including when hospitals will receive total performance scores. In addition, a 1 percent reduction to base-operating diagnosis-related group amounts will be applied for FY 2013 discharges.
6. Value-based incentive payments will be made beginning in January 2013 with respect to discharges occurring in FY 2013.
7. CMS also finalized several policies for the FY 2015 hospital value-based purchasing program, including new measures and finalized performance standards.
CMS has also finalized several requirements for the ASC quality reporting program under the calendar year 2012 Outpatient Prospective Payment System/ASC final rule:
ASC quality reporting program
8. CMS finalized new administrative, data completeness and extraordinary circumstance waivers or extension request requirements, as well as a reconsideration process, for the ASC quality reporting program.
9. ASCs that fail to report quality data or to comply with these requirements will incur a 2 percentage point reduction in their payment update, starting in CY 2014. Data collection for CY 2014 payment determination will begin Oct. 1, 2012.
Hospital-acquired conditions list
10. CMS added "Surgical Site Infection Following Cardiac Implantable Electronic Device" and "Iatrogenic Pneumothorax with Venous Catheterization" to the HAC payment provision for FY 2013.
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In addition to payment updates for inpatient services to Medicare beneficiaries, the rule includes several important changes to federal quality reporting programs:
Hospital inpatient quality reporting program
1. The final rule reduces the number of measures in the inpatient quality reporting program from 72 to 59 for the FY 2015 payment determination and 60 for the FY 2016 payment determination.
2. CMS is reducing the annual random validation sample from 800 hospitals to 400 hospitals. CMS is also reducing the targeted sample to up to 200 hospitals by using specific targeting criteria.
New quality reporting programs
3. CMS has created new quality reporting programs for two types of hospitals that are exempt from payment under the IPPS — inpatient psychiatric facilities and cancer hospitals.
4. CMS finalized an initial set of five quality measures and program requirements for reporting in FY 2013 by cancer hospitals and an initial set of six "process of care" measures for reporting in FY 2013 for inpatient psychiatric facilities.
Hospital value-based purchasing program
5. The IPPS final rule also establishes several operational policies for FY 2013, including when hospitals will receive total performance scores. In addition, a 1 percent reduction to base-operating diagnosis-related group amounts will be applied for FY 2013 discharges.
6. Value-based incentive payments will be made beginning in January 2013 with respect to discharges occurring in FY 2013.
7. CMS also finalized several policies for the FY 2015 hospital value-based purchasing program, including new measures and finalized performance standards.
CMS has also finalized several requirements for the ASC quality reporting program under the calendar year 2012 Outpatient Prospective Payment System/ASC final rule:
ASC quality reporting program
8. CMS finalized new administrative, data completeness and extraordinary circumstance waivers or extension request requirements, as well as a reconsideration process, for the ASC quality reporting program.
9. ASCs that fail to report quality data or to comply with these requirements will incur a 2 percentage point reduction in their payment update, starting in CY 2014. Data collection for CY 2014 payment determination will begin Oct. 1, 2012.
Hospital-acquired conditions list
10. CMS added "Surgical Site Infection Following Cardiac Implantable Electronic Device" and "Iatrogenic Pneumothorax with Venous Catheterization" to the HAC payment provision for FY 2013.
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