CMS Inpatient Rule Hammers 'Excessive' Readmissions, Ups Hospital Payments
The CMS’s final rule to update Medicare's inpatient prospective payment system rates includes the following:
Reporting measures for the rates of MRSA bacteremia, stroke, and venous thromboembolism.
No adoption of its prior proposal to add contrast-induced acute kidney injury to the list of hospital-acquired conditions that are not eligible for Medicare payments.
A directive that hospitals should begin measuring readmission rates for three conditions (acute MI, heart failure, and pneumonia) in preparation for Medicare to begin cutting reimbursement for "excessive" all-cause readmission rates.
Methodology to calculate those excessive readmission rates.
Over 20 new procedure codes, including codes for atherectomy and for endovascular and transapical heart valve procedures.
A Medicare spending-per-beneficiary measure to assess Part A and Part B beneficiary spending from 3 days before a hospital admission through 30 days after a patient is discharged, in an effort to encourage hospitals to provide high-quality care to Medicare beneficiaries at a lower cost.
Decreasing readmissions represents "such a multifactorial problem," she said. "There’s a group of patients it’s possible to keep out of the hospital completely. But there’s another group where, if you can stretch [readmissions] out to every 6 weeks instead of every month, you’re improving."
To improve care and prevent payment cuts relating to that second group of patients, hospitals may need to implement strategies aimed at delaying, rather than preventing, readmission, Dr. Doctoroff said. Those patients also tend to fall lower on the socioeconomic scale, but the new Medicare rules don’t account for socioeconomic status, she said, adding, "I worry very much about the safety-net hospitals."
