1.800.456.4350 info@prgweb.com

Archive for July, 2009

CMS Publishes LTCH, SNF and IRF Final Rules

Friday, July 31st, 2009

The Centers for Medicare & Medicaid Services (CMS) has published the FY 2010 final rules for skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs). The LTCH provisions, which were included in the final inpatient rule, will increase Medicare payments to LTCHs by $153 million. This includes a market basket update of 2.5% minus a 0.5% cut. The SNF final rule calls for payments to Medicare SNFs to be reduced $360 million, primarily through a market basket update of 2.2%. In addition, the rule also finalizes plans to implement a refined payment system in FY 2011. 

The IRF final rule will raise Medicare payments by $145 million, with a market basket update of 2.5%.

The LTCH final rule can be found at http://federalregister.gov/OFRUpload/OFRData/2009-18663_PI.pdf

The SNF rule can be found at http://frwebgate5.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=182373145443+2+2+0&WAISaction=retrieve

The IRF rule can be found at http://frwebgate2.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=kkgS8Y/0/2/0&WAISaction=retrieve

ARRA to Fund State Efforts to Improve ASC Care

Thursday, July 30th, 2009

The Centers for Medicare & Medicaid Services (CMS) has awarded an initial $572,250 in American Recovery and Reinvestment Act (ARRA) funds for state efforts to reduce healthcare-associated infections in ambulatory surgical centers. Twelve states – Maine, New Jersey, Maryland, Florida, North Carolina, Indiana, Michigan, Arkansas, Oregon, Utah, Wyoming and Kansas- will survey more than 125 ambulatory surgical centers (ASCs) before September 30 to ensure that the facilities are following Medicare’s health and safety standards. In addition, the CDC will make $40 million available to state public health departments for state-based HAI prevention and surveillance efforts.

A press release can be viewed at here

Comparative Effectiveness Research Priorities Identified

Monday, July 20th, 2009

An Institute of Medicine (IOM) committee has identified 100 topics that will receive priority funding from a new national research effort to evaluate the relative effectiveness of different health care services and treatment options. These topics include the treatment of atrial fibrillation and congestive heart failure. The American Recovery and Reinvestment Act (ARRA) allocated $400 million for comparative effectiveness research (CER), and required IOM to recommend how the funds could best support such research.

For further details, visit http://www.iom.edu/?ID=71025

CDC Issues H1N1 Guidance

Wednesday, July 15th, 2009

The Centers for Disease Control and Prevention (CDC) issued guidance to assist medical offices and other outpatient facilities in preparing for a potential surge in H1N1 flu patients. The agency recommends that facilities develop a business continuity plan, follow guidelines for identifying and caring for H1N1 patients, take steps to protect the health of their workforce, and coordinate their planning and response activities with hospitals and other providers in the community.

The guidance document is available at http://www.cdc.gov/h1n1flu/10steps.htm.

Changes to Hospital Cost Report Form Proposed

Tuesday, July 14th, 2009

The Centers for Medicare & Medicaid Services (CMS) has proposed making changes to the hospital cost report form. The proposed new form would apply to cost reporting periods beginning February 1, 2010. The AHA is reviewing the form and plans to submit comments.

More information is available at http://edocket.access.gpo.gov/2009/pdf/E9-15526.pdf.

Surgeon General Nominated

Monday, July 13th, 2009

President Obama has nominated Regina Benjamin for U.S. surgeon general.  Benjamin is founder and CEO of the Bayou La Batre (AL) Rural Health Clinic. She is also the immediate past-chair of the Federation of State Medical Boards, and previously served as associate dean for rural health at the University of South Alabama College of Medicine. In 2002, she served as president of the Medical Association of the State of Alabama, the first African-American woman to lead a state medical society.

A press release can be viewed at http://www.whitehouse.gov/the_press_office/President-Obama-Announces-Nominee-for-Surgeon-General-7-13-09/

30-Day Readmission Data Posted

Thursday, July 9th, 2009

The Hospital Quality Alliance (HQA) has posted to the Hospital Compare Web site its first data on hospital readmission rates for Medicare patients treated for heart attack, heart failure and pneumonia. Based on Medicare billing records from July 2005 to June 2008, the data show how often patients with each of these conditions return to the same or a different hospital within 30 days of discharge, and how each hospital’s readmission rates compare to the average rates for the state and nation. In addition, Hospital Compare has been updated with the latest data on 30-day mortality rates for patients hospitalized with a principal diagnosis of heart attack, heart failure and pneumonia.

The Hospital Compare website is located at http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home

2010 Proposed Rule for the Medicare Physician Fee Schedule (MPFS)

Thursday, July 2nd, 2009

On July 1, the Centers for Medicare & Medicaid Services (CMS) released its MPFS proposed rule for CY 2010. The proposed rule calls for a decrease in Medicare payments to physicians by -21.5% as a result of the sustainable growth rate formula (SGR).  Comments will be accepted until August 31. The final rule will be published by November 1. Provisions will be implemented January 1, 2010.

Key highlights of the proposed MPFS rule include:

  • The conversion factor for the MPFS to be $28.3208. 
  • Removal of drugs from the calculation of allowed and actual expenditures used in the SGR formula.
  • Changes to the practice expense and malpractice values that will have an impact of -11 percent for cardiovascular procedures.
  • An update to the practice expense data used in the calculation of practice expense values in the physician fee schedule to include new practice expense per hour data from the Physician Practice Information Survey conducted by the AMA.
  • Discontinuing payment for Consultation codes. Instead, consultation services would be reported with existing E&M service codes.
  • No changes to the payment localities were proposed.  However, the 1.00 work GPCI floor will be removed as of January 1, 2010, as required by Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, which will result in 54 out of 89 physician fee schedule localities receiving a decrease in their work geographic practice cost index. 
  • A change to the equipment utilization rate from the current 50% to 90% for equipment priced over $1 million.

For further details, go to http://www.federalregister.gov/OFRUpload/OFRData/2009-15835_PI.pdf

2010 Proposed Rule for Hospital Outpatient Prospective Payment System (HOPPS)

Thursday, July 2nd, 2009

On July 1, 2009, the Centers for Medicare & Medicaid Services (CMS) issued the 2010 proposed HOPPS rule on their website. CMS projects that proposed payment rates under the outpatient prospective payment system would result in a 1.9% increase in Medicare payment.  The final rule will be published in November of this year and will be implemented on January 1, 2010. 

Key provisions of the proposed rule include:

  • No new composite APCs will be developed for CY 2010. 
  • Continuation of the requirement that hospitals participating in the Hospital Outpatient Quality Data Reporting Program (HOP QDRP) report the existing 7 chart-abstracted emergency department and perioperative measures, and 4 existing claims-based imaging efficiency measures for the HOP QDRP for CY 2011 payment determination. 
  • The packaging threshold for drugs and biologicals will be $65, a $5 increase from the current threshold of $60.
  • Continuation of the pass-through status in CY 2010 for 31 drugs and biologicals at an average sales price (ASP) plus 6 percent.
  • Revision of some of the current policies for physician supervision of outpatient services.  For example, CMS is proposing that nonphysician practitioners may directly supervise all hospital outpatient therapeutic services that they are able to personally perform within their state scope of practice and hospital-granted privileges.  Under current policy, only physicians may provide the direct supervision of these services. 

The proposed rule is available in the Federal Register at http://edocket.access.gpo.gov/2009/pdf/E9-15882.pdf.