Archive for April, 2012

CMS Proposes 2013 Pay Rate Hike for Hospitals

30 Apr


The Centers for Medicare & Medicaid Services (CMS) just issued a proposed rule to update 2013 Medicare, which includes a payment rate increase of 2.3 percent for inpatient stays at general acute care hospitals. The increase would raise total Medicare spending for inpatient hospital care by about $175 million.
According to a CMS statement: “The rate increase, together with other policies in the proposed rule and projected utilization of inpatient services, would increase Medicare’s operating payments to acute care hospitals by approximately 0.9% in fiscal year 2013.”
However, there is also a provision to reduce payments by two percentage points beginning in fiscal 2013 for hospitals that have excess readmissions for MI, heart failure, and pneumonia.
CMS is also proposing medical coding additions to the existing Vascular Catheter-associated Infection HAC category, ICD-9:
– 999.32 Bloodstream infection due to central venous catheter
– 999.33 Local infection due to central venous catheter
Those LTCHs that fail to meet the quality measures will see payment rates cut starting in 2016.
The proposed rule would also include a one-year extension of the existing moratorium on the “25 percent threshold” policy, pending results of an ongoing research initiative to redefine the role of LTCHs in the Medicare program. Currently, the legislative moratorium expires at the end of 2012.
The American Hospital Association (AHA) responded by saying: “While we commend CMS for delaying the full implementation of the 25 percent rule for long-term care hospitals (LTCHs), we are troubled that the delay does not fully apply to all LTCHs this year. Leaving the proposal as is could arbitrarily prohibit some patients from receiving needed long-term care.”
A final version of the proposal is expected to arrive on August 1. CMS will accept comments on the proposed rules until June 25.

CMS Picks First Medicare Shared Savings Program ACOs

19 Apr


The first 27 accountable care organizations (ACOs) to fall under the Medicare Shared Savings Program have been chosen by the Centers for Medicare & Medicaid Services (CMS). Accountable care organizations are one of the more talked about items in healthcare reform. They are being created to bring about financial incentives for doctors, hospitals, and other healthcare providers to better coordinate care, lower their costs, and improve the health of Medicare beneficiaries.
Among the 27 healthcare entities in 18 states are more than 10,000 physicians, 10 hospitals, and 13 smaller physician-led entities. They are estimated to serve more than 375,000 beneficiaries. According to the CMS, this most recent ACO announcement increases the number of Medicare beneficiaries participating in various shared-savings initiatives to 1.1 million. In January, the modified Pioneer Model ACOs (32 healthcare groups) and six Physician Group Practice Transition Demonstration organizations were launched.
“There were some people who feared that the only entities that would participate would be hospital-dominated systems,” said Jonathan Blum, Director of the Center for Medicare at the CMS. “That has not happened.”
It was announced by the CMS last summer that 7 out of 10 physician groups that participated in the their Physician Group Practice Demonstration achieved benchmarks on all 32 performance measures in the fifth year of the project. However, a January Congressional Budget Office report on 10 ACOs and disease management initiatives found insufficient savings to offset cost.
Blum expects the new ACOs to have more success controlling healthcare costs than similar payment and delivery reform pilot projects previously authorized within Medicare. 
“We are encouraged by this strong start and confident that by the end of this year, we will have a robust program in place, benefitting millions of seniors and people with disabilities across the country,” said acting CMS administrator Marilyn Tavenner in a written statement.
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Posted in Medicare