By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA
CMS releases payment rate proposals for hospitals, SNFs, IRFs
The Centers for Medicare & Medicaid Services (CMS) released its annual series of proposed payment regulations for hospitals, skilled nursing facilities (SNFs), and inpatient rehabilitation facilities (IRFs) in late April. Along with new rule and policy change proposals, CMS recommends overall payment increases for each market effective Oct. 1, 2015 (FY 2016), similar to its proposed changes in 2014.
These proposed policies carry immediate and long-term effects, so it’s important to understand how these changes would affect your customers’ operations if approved. Below are some highlights:
Hospitals
- An average 1.1 percent annual payment increase
- Revised pneumonia measure for the Hospital Readmissions Reduction program for FY 2017
- Extraordinary circumstance exception added to the Hospital Readmissions Reduction Program in FY 2016 for hospitals that experience a disaster
- Value-Based Purchasing Program funding pool increase to 1.75 percent of total Medicare payments
- One new proposed measure for Value-Based Purchasing in 2021:
- Hospital 30-day all-cause mortality rate for COPD
- Two measures removed for Value-Based Purchasing in FY 2018:
- Influenza vaccination (CMS believes it is “topped” out)
- Heart attack fibrolynic therapy received within 30 minutes (most patients receive percutaneous coronary intervention instead)
- No changes for the Infection Policy in FY 2016
SNFs
- Overall 1.4 percent increase in Medicare payments, or $500 million collectively:
- Rural area payments would only increase by 0.8 percent, while urban area payments would increase by 1.5 percent
- New England and Middle Atlantic facilities would receive the largest regional urban payment increases at 2.1 percent, while urban West North Central region payments would receive the lowest increase
at 1.0 percent - Three patient measures included in the SNF quality reporting program slated to begin Oct. 1, 2017:
- Skin integrity and changes in skin integrity
- Incidence of major falls
- Functional status, cognitive function, and changes in function and cognitive function
- New all-cause, all-condition readmission measure added to the SNF Value-Based Purchasing Program set to begin Oct. 1, 2018; this program will link Medicare payment to performance by promoting the development and use of quality measures, such as those mentioned above
Inpatient Rehabilitation Facilities
- A 1.7 percent annual payment increase, or $130 million collectively, slightly less than the 2014 proposal
- Facility-level payment adjustment freeze that would continue for the second consecutive year
- Three quality metrics (similar to the new SNF quality metrics reported above) added to the IRF Quality Reporting Program, as well as the reporting programs for long-term care hospitals, and home health agencies.
- Requirement to publically disclose quality reporting program data beginning Oct. 1, 2016 (FY 2017)
HIDA Government Affairs has provided more detailed summaries (available at www.HIDA.org) of these proposed rules for sales reps and other supply chain professionals, and will update the summaries when the final payment regulations are released in early August.
CMS is expected to release a subsequent series of proposed payment rate proposals in the coming months for providers that are paid on a calendar year including physicians, laboratory, and home health agencies. These rules are finalized in the fall and will take effect on Jan. 1, 2016 (CY 2016).
For more information on these current and future market proposals, contact us at HIDAGovAffairs@hida.org.