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Archive for April, 2011

Proposed SNF Rules Released

Friday, April 29th, 2011

The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the skilled nursing facility (SNF) prospective payment system (PPS). In the proposed rule, CMS proposes two different options for updating the SNF PPS. The first option, based on only one quarter’s data, is an 11.3% cut, or $4.47 billion. These cuts will be used to adjust for greater than projected utilization of the highest paid therapy payment categories implemented under the SNF payment refinements that became effective last October. However, the recalibration cut would be offset by the fiscal year 2012 market basket, for a net reduction of only $3.94 billion. The second payment update option is a net increase of 1.5%, or $530 million, which includes the 2.7% market basket update minus the 1.2% productivity adjustment. Comments on the proposed rule are due by June 27.

The proposed rule can be found by going to http://www.access.gpo.gov/su_docs/fedreg/a110506c.html

Final Rule for VBP Published

Friday, April 29th, 2011

The Centers for Medicare & Medicaid Services (CMS) published a final rule for the hospital value-based purchasing (VBP) program. Under the Affordable Care Act (ACA), the VBP program will pay hospitals based on their actual performance on quality measures  beginning in fiscal year (FY) 2013. During FY 2013, the VBP program will include 12 clinical quality measures as well as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experiences with care survey. The clinical measures will account for 70% of a hospital’s VBP score and the HCAHPS survey for 30%. The VBP program will apply to most acute-care prospective payment system hospitals.

For more information on the Hospital VBP program, visit www.HealthCare.gov/news/factsheets/valuebasedpurchasing04292011a.html or www.cms.gov/apps/media/fact_sheets.asp.

CMS Issues RAC Report

Wednesday, April 27th, 2011

According to a report from the Centers for Medicare & Medicaid Services (CMS), Medicare’s recovery audit contractors (RAC) have collected $313.2 million in alleged overpayments from health care providers since October 2009, while paying providers $52.6 million in underpayments. The report also identifies the top overpayment issues in each of the four RAC regions.

For more information, go to http://www.cms.gov/RAC/Downloads/FFSNewsletter.pdf

Inpatient Rehabilitation Proposed Rule Issued

Monday, April 25th, 2011

The Centers for Medicare & Medicaid Services (CMS) issued the inpatient rehabilitation hospital prospective payment system (IRFPPS) proposed rule for fiscal year 2012. The rule includes the statutorily required market basket update of 2.8%, which would be offset by a 0.1% cut and productivity adjustment of -1.2%, as required by the Affordable Care Act (ACA). These market basket reductions combined with a 0.3% update to IRF outlier payments produce a net update for FY 2012 of 1.8%, an increase of $120 million over FY 2011 Medicare payments. In addition, CMS proposes two new mandatory quality measures: catheter-associated urinary tract infections and pressure ulcers that are new or have worsened. Comments on the proposed rule are due to CMS by June 21.

The proposed rule can be found by going to http://edocket.access.gpo.gov/2011/pdf/2011-10159.pdf.

Data Shows Gains in Quality Indicators

Wednesday, April 20th, 2011

The Centers for Medicare & Medicaid Services (CMS) issued a report that highlights significant trends in the growth of two important “pay-for reporting” programs – the Physician Quality Reporting System and ePrescribing Incentive System. The report also articulates key areas in which physician-level quality measures appear to show positive results in quality of care delivered to Medicare beneficiaries.

For further details, the CMS press release can be found by going to this link.

FY 2012 Proposed IPPS and LTCH Rule Issued

Wednesday, April 20th, 2011

On April 19, the Centers for Medicare & Medicaid Services (CMS) issued the FY 2012 inpatient hospital prospective payment system (IPPS) and long-term care prospective payment system (LTCH) proposed rule. Under the proposed rule, CMS projects that Medicare operating payments to acute care hospitals for discharges occurring in FY 2012 would decrease by a projected $498 million or 0.5%. This includes a hospital update of 1.5% (based on a projected market basket update of 2.8, reduced by a productivity adjustment and an additional 0.1%), increased by 1.1% in response to litigation, as well as a reduction of 3.15 percentage points to account for changes in documentation and coding following adoption of the MS-DRGs that did not reflect actual increases in patients’ severity of illness. Medicare payments to LTCHs are projected to increase by $95 million or 1.9%. CMS will accept public comments on the proposed rule until June 20.

The display copy of the proposed rule can be found by going to this link.

Community-based Care Transitions Program Applications Being Accepted

Thursday, April 14th, 2011

The Centers for Medicare & Medicaid Services (CMS) is accepting applications from hospitals and community-based organizations eligible to participate in the Community-based Care Transitions Program. This Medicare demonstration program will provide $500 million over five years for care transition services for Medicare patients at high-risk for readmission. Hospitals with 30-day readmission rates in the top quartile in their state for heart attack, heart failure and/or pneumonia are eligible to submit an application in partnership with community-based organizations that provide care transition services.

For more information, go to http://www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313

HHS Announces Partnership for Patients

Wednesday, April 13th, 2011

Health and Human Services (HHS) Secretary Kathleen Sebelius has announced the Partnership for Patients: Better Care, Lower Costs initiative which is a collaboration with hospitals and others to reduce hospital acquired conditions (HACs) and preventable hospital readmissions. The initiative will use $1 billion in Patient Protection and Affordable Care Act (ACA) funding to test models for safer care delivery, promote best practices and help Medicare patients at high risk for readmission safely transition from the hospital to other care settings. By 2014, participants hope to reduce HACs by 40% and preventable readmissions by 20% to save up to $35 billion across the health care system.

For more information about the program, go to http://www.healthcare.gov/center/programs/partnership

National Coordinator for Health IT Announced

Friday, April 8th, 2011

Health and Human Services Secretary Kathleen Sebelius announced that Farzad Mostashari, M.D., ScM, will become the new national coordinator for health information technology. Mostashari joined HHS’ Office of the National Coordinator (ONC) for Health IT in July 2009 as deputy national coordinator for programs and policy. Prior to ONC, Mostashari was an assistant commissioner for the New York City Department of Health and Mental Hygiene.


The announcement can be found at http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=1249&PageID=18220