On July 31, 2008 the Centers for Medicare & Medicaid Services (CMS) issued the annual updates and payment rules for the Hospital Inpatient Prospective Payment System (HIPPS) for fiscal year (FY) 2009. In FY 2008, payments to all participating hospitals are expected to increase by an average of 3.6%. The rule also finalizes additional changes to the Medicare Severity Long-Term Care Diagnosis Related Groups (MS-LTC-DRGs). Medicare payment for acute care hospital are estimated to increase by nearly $4.75 billion based on the charges in the final rule.
The key provisions of the final rule address improvements to the hospital quality initiatives, which expands the list of quality measures to 42, and physician self-referral. Under the rule, only physicians with an ownership or investment interest in a physician organization are deemed to “stand in the shoes” of that organization for purposes of analyzing a financial arrangement under the self-referral law.
Other provisions are:
- Completion of the 3 year transition to replace charge based-weights with cost based-weights
- The addition of health care-acquired conditions (HAC) to include surgical site infections following certain orthopedic procedures and bariatric surgery for obesity; manifestations of poor blood sugar control, such as diabetic ketoacidosis and hypoglycemic coma; and deep vein thrombosis or pulmonary embolism associated with total knee and hip replacement procedures.
- Finalization of CMS’ proposals related to the hospital wage index with transitions.
- Cuts to capital indirect medical education payments
- Assignment of cases that use a total artificial heart to a higher-paying MS-DRG and approval for new technology add-on payment in approved clinical trial settings
- Payment provisions to reduce “never events” that occur in hospitals
- Changes to the Emergency Medical Treatment and Labor Act (EMTALA)
The final rule was published in the August 19 Federal Register and will take effect on October 1. It is available at http://www.access.gpo.gov/su_docs/fedreg/a080819c.html.