The Centers for Medicare & Medicaid Services late today issued its long-term care hospital prospective payment system final rule for fiscal year 2016. The rule implements the new dual-rate payment structure for LTCHs, which will be phased in through a two-year transition that begins Oct. 1. In general, the two-tiered system will pay traditional LTCH PPS rates for higher acuity patients and lower, “site-neutral” rates similar to inpatient PPS rates for less medically complex cases. For FY 2016, LTCH PPS rates would increase by 1.7% overall, which includes a 2.4% market-basket update, mandatory cuts of 0.5 percentage point for productivity and an additional 0.2 percentage point, a 0.2 percentage point increase for short-stay outlier payments, and a 0.1 percentage point cut for high-cost outlier payments. With regard to CMS’s final methodology for site-neutral payments, the agency implemented several key AHA recommendations, such as eliminating use of inpatient PPS discharge status codes to identify cases eligible for a standard LTCH PPS payment. “At a time when LTCHs are seeing payment reductions for one out of every two patients, abandoning the use of discharge status codes is appreciated by these hospitals who are navigating new and choppy waters,” said Ashley Thompson, AHA vice president and deputy director, policy. In addition, CMS lowered the proposed fixed-loss amount for high-cost outlier cases, which will increase the accuracy of payments for standard LTCH PPS cases. However, Thompson expressed concern that it appears that the agency will apply two budget-neutrality adjustments related to site-neutral outlier payments that result in rates that are lower than inpatient PPS rates, which would be duplicative and unwarranted. Lastly, CMS finalizes three measures for the FY 2018 LTCH quality reporting program to satisfy the requirements of the Improving Medicare Post Acute Transformation Act of 2014. The measures assess skin integrity, falls with major injury and all-cause readmissions. CMS also will begin publicly reporting certain LTCH QRP quality data by the fall of 2016. The rule’s provisions will take effect Oct. 1.
News Item - 08/01/2015
CMS issues final FY 2016 inpatient PPS rule
The Centers for Medicare & Medicaid Services late today issued its hospital inpatient prospective payment system final rule for fiscal year 2016, which will increase rates by 0.9% after accounting for inflation and other adjustments required by law. Specifically, the final rule includes an initial market-basket update of 2.4% for those hospitals that were meaningful users of electronic health records in FY 2014 and that submit data on quality measures, less a productivity cut of 0.5 percentage point and an additional market-basket cut of 0.2 percentage point, as mandated by the Affordable Care Act. In addition, CMS finalizes a 0.8 percentage point cut that would, in part, fulfill the requirement of the American Taxpayer Relief Act of 2012 that the agency recoup what it claims is the effect of documentation and coding changes from FYs 2010-2012, which CMS says do not reflect real changes in case mix. The rule also includes ACA-mandated Medicare Disproportionate Share Hospital reductions, which will reduce overall Medicare DSH payments by $1.2 billion in FY 2016. CMS also finalizes its proposal to require hospitals to submit certain clinical quality measures electronically in calendar year 2016 for payment in the FY 2018 Inpatient Quality Reporting program. However, the agency will require the submission of four electronic clinical quality measures rather than the 16 it had proposed. CMS also will expand the patient population of the pneumonia readmission measure used in the Hospital Readmissions Reduction Program beginning in FY 2017 but will exclude certain patients from the expanded population. CMS did not extend the partial enforcement delay of the two-midnight policy that expires on Sept.30, despite proposing changes to the policy in the outpatient PPS rule that would not take effect before Jan. 1, 2016. Ashley Thompson, AHA vice president and deputy director, policy, said hospitals were “dismayed” by the lack of a delay. “Hospitals need this delay…We urge CMS to issue an extension of the delay quickly.” Most of the provisions in the final rule will take effect Oct. 1. AHA staff are reviewing the rule, and members will receive a Special Bulletin on Monday with further details.
News Item - 07/30/2015
In the United States, one out of every five adults has a disability, according to a new study published by the Centers for Disease Control and Prevention.
The most common functional disability type was a mobility limitation – defined as serious difficulty walking or climbing stairs -- reported by one in eight adults, followed by disability in thinking and/or memory, independent living, vision, and self-care.
The researchers found that the highest percentages of people with disabilities are generally in Southern states, for example Alabama (31.5 percent), Mississippi (31.4 percent), and Tennessee (31.4 percent). The report did not determine why differences occur by state; however, states in the South tend to have some of the higher rates of chronic diseases, such as heart disease and diabetes, which may also be associated with disability.
The report also revealed that non-Hispanic black (29 percent) and Hispanic (25.9 percent) adults were more likely to have a disability than were white non-Hispanic (20.6 percent) adults. Those with lower education levels, lower incomes, and those who are unemployed were also more likely to report a disability.
Although disability information has been collected in national surveys for many years, this was the first time that functional disability type was included in the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an annual, state-based telephone survey conducted by states in collaboration with CDC that gathers information on demographics, health status, health behaviors and disabilities.
CMS projects higher healthcare spending growth through 2024
by Bob Herman
The historically low growth rates of national health spending over the last several years may be history. CMS officials say the Affordable Care Act's insurance expansion, an improving economy, an aging population, and expensive new drugs are pushing up health costs once again.
U.S. health spending is expected to grow 5.8% annually between 2014 and 2024, according to projections from CMS economists and actuaries published Tuesday in Health Affairs. The amount spent on healthcare in 2014 alone is projected to have risen 5.5%—the first time since 2007 that the growth rate exceeded 5%. The high prices of hepatitis C drugs contributed to that faster spending increase, actuaries said on a call with reporters.
Trends in Observed Adult Inpatient Mortality for High-Volume Conditions, 2002-2012
by Anika L. Hines, Ph.D., M.P.H., Kevin C. Heslin, Ph.D., H. Joanna Jiang, Ph.D., and Rosanna Coffey, Ph.D.
Monitoring and improving health care quality in the United States is a key priority for health policymakers, payers, providers, and patient advocates. Hospital inpatient mortality is one quality measure that can reflect both improvements in health care and shifts in where end-of-life care takes place over time.
Previous trends in inpatient mortality suggest that rates have been decreasing for high-volume conditions, such as acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, and pneumonia. These declines in mortality vary not only by condition but also by patient and hospital characteristics. Continued study of these trends can help researchers and policymakers assess the impact of health care quality efforts. Further, examining trends across patient and hospital subgroups may inform strategies for addressing disparities in health care quality by identifying groups that are leading and lagging in improvement.
HHS seeks to have 85 percent of Medicare fee-for-service payments in value-based purchasing categories 2 through 4 by 2016 and 90 percent by 2018
Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs.
When it comes to improving the way providers are paid, we want to reward value and care coordination – rather than volume and care duplication. In partnership with the private sector, the Department of Health and Human Services (HHS) is testing and expanding new health care payment models that can improve health care quality and reduce its cost.