The Centers for Medicare & Medicaid Services has issued a final rule that updates fiscal year 2013 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals, with an eye toward slowing growth in future healthcare costs by improving patient care.
The final rule also implements key elements of the Affordable Care Acts hospital value-based purchasing and hospital readmissions reduction programs. It advances federal efforts to tie Medicare payments to quality healthcare across the delivery system, with new quality reporting measures for general acute care hospitals in FY 2015 and FY 2016, new measures for long-term care hospitals in FY 2016 and new quality reporting programs for psychiatric hospitals and cancer hospitals.
In addition, the rule establishes new reporting and other requirements for the Ambulatory Surgical Center Quality Reporting Program.
“Hospitals are at the forefront of our strategy to both save money and improve the quality and coordination of care,” CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA, said in a news release. “This rule takes further important steps to ensure all patients receive the best possible care.”
To provide hospitals with an incentive to reduce hospital readmissions and improve care coordination, the Affordable Care Act created a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 (for discharges on or after Oct. 1, 2012) to certain hospitals that have excess readmissions for three selected conditions: myocardial infarction, heart failure and pneumonia. The new rule finalizes a methodology and the payment adjustment factors to account for excess readmissions for these three conditions.
The final rule also:
• Strengthens the Hospital Value-Based Purchasing Program to reward efficient, high-quality care. This program, created by the Affordable Care Act, will adjust hospital payments beginning in FY 2013 and annually thereafter based on how well hospitals perform or improve their performance on a set of quality measures.
• Includes a new outcome measure, the central line-associated bloodstream infection measure, in the VBP program.
• Strengthens the Inpatient Quality Reporting program. Specifically, CMS has included measures for perinatal care and readmissions, including overall readmissions and readmissions relating to hip and knee replacement procedures and a measure related to whether hospitals use surgery checklists. CMS also has added a new survey measure to the Hospital Consumer Assessment of Healthcare Providers and Systems measures to assess the quality of care for patients as they transition from one care setting to another.
• Builds on CMS quality reporting initiatives by adopting the measures that will be used for LTCHs for the FY 2015 and FY 2016 quality-based payment determinations, and establishing quality reporting for psychiatric hospitals and psychiatric units that are paid under the Inpatient Psychiatric Facilities Prospective Payment System and for PPS-exempt cancer hospitals. Reporting and other requirements are also finalized for the Ambulatory Surgical Center Quality Reporting program.
For details of the FY 2013 payment rate changes, visit http://go.cms.gov/OK8hTp. For more on patient care provisions, visit http://go.cms.gov/NeObxm.