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.