The 2015 Medicare payment regulations for hospitals, physicians, and ambulatory surgical centers contain a vast array of changes in payment policies and rates. Yet a common theme weaves through many of these policies regardless of payment system or delivery setting—that is, the search for greater value in Medicare spending by encouraging new ways to pay for and deliver health care.
In 2015, CMS is expanding or refining programs that:
- reduce readmissions and hospital-acquired conditions
- encourage greater integration and coordination among providers, and
- link reimbursement to how well providers improve care and reduce costs.
In its 2015 regulation for inpatient hospital services, for example, CMS for the first time is applying a 1% payment reduction to hospitals that rank in the bottom 25% of hospitals in avoiding hospital acquired conditions. On preventable readmissions, the agency is increasing the maximum penalty—to 3% of hospital payments—for those hospitals with an excess number of readmissions. It estimates that this program has resulted in 150,000 fewer readmissions in 2012 and 2013.
Beginning in 2015, value based purchasing (VBP)—which has applied only to hospital inpatient care providers—will expand to include physicians in large practices. By 2017, it will include all physicians. Also, CMS is expanding the potential penalties and bonuses under VBP for hospitals and physicians and will judge performance increasingly on patient outcomes measures, such as mortality, morbidity, patient satisfaction, and costs—not just process measures.
The 2015 payment rules also include policies to continue closer integration and coordination among providers. That includes continued implementation of accountable care organizations, the electronic health records incentive program, and chronic care coordination. For example, CMS is authorizing a separate payment for chronic care management services physicians provide to Medicare beneficiaries who have multiple chronic conditions. The extra payment covers such non-face-to-face services as developing a plan of care for the patient and communicating with other health providers who are treating the patient.
The final regulations also reflect continued changes in payment policy to restrict or reduce payment. One technique CMS is using in hospital outpatient payment involves making payments for larger groupings of items and services rather than making separate payments for each individual service.
The policies for hospital outpatient departments, ASCs, and physicians go into effect in January 2015. Those for hospital inpatient services went into effect at the start of Fiscal Year 2015, which was October 1, 2014