Medicare inpatient payment rates will rise, quality-performance reporting will expand, and Medicare will continue its shift toward paying providers for quality, rather the quantity.Those are among the highlights of the Centers for Medicare & Medicaid Services final policy and payment regulation for Medicare inpatient services for the fiscal year 2016, which begins October 1, 2015.
- Payment rates will increase 0.9% for hospitals that successfully participate in the hospital quality reporting program and demonstrate meaningful use of certified electronic health record technology. Those that do not will face downward adjustments.
- Quality-related provisions include continued penalties for preventable readmissions, a continued -1.0% penalty for hospitals performing in the lowest 25% in reducing hospital-acquired conditions, and continued bonuses and penalties for hospital value-based purchasing.
- With regard to value-based purchasing, CMS is updating and expanding the number of quality measures, including a care coordination measure starting in FY 2018 and a 30-day mortality measure for chronic obstructive pulmonary disease beginning in FY 2021.
- CMS is updating and adjusting quality measures in the quality performance reporting programs for hospital inpatient care, cancer hospitals that are exempt from inpatient prospective payment, and long-term care hospitals. This includes a new quality measure requiring long-term care hospitals to report the percentage of residents that experience falls resulting in major injury.
- Prospective payments for many long-term care hospitals would decrease by -4.6%, or about $250 million, as CMS continues to make changes in the LTCH prospective payment system.
- CMS says that some of the payment reductions included in the final regulation recoup coding overpayments related to the transition to MS-DRGs that began in fiscal year 2008
