Thursday, July 31, 2008

Medicare Part A changes

The Centers for Medicare and Medicaid Services announced today that the agency has finalize the rule on changes to Medicare's acute hospital care payment methodology for discharges occurring on or after October 1, 2008, the beginning of the federal government's fiscal year. The announcement explains various revisions to Medicare's never events and quality improvement programs:

The IPPS rule adds conditions, including one NQF never event, to the list of conditions that have been determined to be reasonably preventable through proper care. Beginning last year, as required by the Deficit Reduction Act of 2005 (DRA), CMS began selecting hospital-acquired conditions (HACs) that were determined to be reasonably preventable. If a condition is not present upon admission, but is subsequently acquired during the hospital stay, Medicare will no longer pay the additional cost of the hospitalization. The patient is not responsible for the additional cost. Rather, the hospital is being encouraged to prevent an adverse event and improve the reliability of care it is giving to Medicare patients.

In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:

· Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity

· Certain manifestations of poor control of blood sugar levels

· Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

The final rule issued today also expands the Reporting Hospital Quality Data for Annual Payment Update Program. The Medicare law requires CMS to reduce payments to hospitals that do not successfully report quality measures adopted under the program by two percent from the percentage increase that would otherwise apply to their payment rates. The quality measures are publicly reported on the CMS Hospital Compare Web site, a tool that can be used by beneficiaries in choosing where to receive treatment.

Hospitals are currently required to report 30 quality measures on their claims for Medicare inpatient services to qualify for a full update to their FY 2009 payment rates. CMS had discussed 43 new quality measures in the proposed rule and requested public comment on those measures. After reviewing public comments on the proposed rule, CMS decided to add only 13 measures.

The rule will be posted on the Federal Register's website tomorrow, and it will be published in the Federal Register's print edition on August 19.

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