106
C
MS has issued its inpatient prospective
payments systems final rule for fiscal year
2016, which calls for an increase in Medi-
care reimbursements to some hospitals in the next
fiscal year.
e 2,149-page rule also includes rates for long-
term care hospitals. Overall, the rule will apply
to about 3,400 acute care hospitals and 435 long-
term care hospitals.
Here are 10 of the most important points to know
about CMS' final IPPS rule for FY 2016.
Hospital payments
1. Under the final rule, acute care hospitals that
report quality data and are also meaningful us-
ers of EHRs will receive a 0.9 percent increase in
Medicare operating rates. Hospitals that do not
submit quality data would lose a quarter of the
market basket update (2.4 percent), and hospitals
that are not meaningful users of EHRs would lose
one-half of the market basket update in FY 2016.
2. CMS arrived at its proposed rate of 0.9 percent
(again, which only would apply to hospitals that
report quality data and attest to meaningful use)
through the following updates: a positive 2.4 percent
market basket update, a negative 0.5 update for a pro-
ductivity adjustment, a negative 0.2 percent update
for cuts under the Affordable Care Act and a negative
0.8 percent documentation and coding adjustment
as part of the American Taxpayer Relief Act of 2012.
Legislators included $11 billion in MS-DRG docu-
mentation and coding adjustments in that bill. is
meant hospitals and other providers would lose $11
billion in Medicare payments between fiscal 2014 and
fiscal 2017 due to past overpayments the government
made to hospitals during the transition to MS-DRGs.
Hospital-Acquired Condition
Reduction program
3. Under the final rule, hospitals with the poorest
performance in reducing HACs, specifically those
in the lowest quartile, will have their Medicare
pay docked by 1 percent.
Medicare disproportionate
share hospital payments
4. As part of the ACA, Medicare disproportion-
ate share hospital payments will be reduced by 75
percent, or $49.9 billion, by 2019. Under the final
rule, overall DSH payments will be cut by $1.2
billion in FY 2016, compared to the estimated
FY 2015 amount. "e decrease is primarily at-
tributable to continued declines in the number of
uninsured individuals since the passage of the Af-
fordable Care Act," according to CMS.
Bundled Payments for Care
Improvement initiative
5. In 2011, CMS launched the BPCI initiative, link-
ing payments for multiple services during an epi-
sode of care into a bundled payment. In the final
rule, CMS thanks commenters for their feedback
on policy and operational issues surrounding the
potential future expansion of this initiative.
Hospital Inpatient Quality
Reporting program
6. Under the final rule, CMS adds seven new measures
to the HIQR program. ere are three new claims-
based measures and one structural measure added
for the FY 2018 program and subsequent years, and
there are three new claims-based measures added for
the FY 2019 program and subsequent years.
Hospital Value-Based
Purchasing program
7. In the final rule, CMS makes changes to the
Hospital Value-Based Purchasing program, which
was established under the ACA. CMS is adding a
care coordination measure beginning with the FY
2018 program year and a 30-day mortality mea-
sure for chronic obstructive pulmonary disease
beginning with the FY 2021 program year.
8. CMS is also removing two measures, effective
with the FY 2018 program year.
PSS-Exempt Cancer Hospital
Quality Reporting Program
9. Established by the ACA, the PCHQR program
collects and publishes data on an announced set of
quality measures. In the final rule, CMS finalizes
three new patient safety measures under the pro-
gram. e three new measures are: a Clostridium dif-
ficile infection outcome measure, a Hospital-Onset
Methicillin-resistant Staphylococcus aureus bactere-
mia outcome measure and a measure of influenza
vaccination coverage among healthcare personnel.
10. e final rule will be published in the Federal
Register Aug. 17. Comments on the rule are due
Sept. 29, and the rule is effective Oct. 1. n
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ADVERTISER
CMS' Final IPPS Rule for 2016: 10 Things to Know
By Ayla Ellison
