Below, please find the proposed 2018 Medicare Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) prospective payment rule issued April 14 by the Centers for Medicare and Medicaid Services (CMS). CMS states that the proposed rule "aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care." CMS notes that the proposed increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users is approximately 1.6 percent. CMS projects that the rate increase, together with other proposed changes to IPPS payment policies, will increase IPPS operating payments by approximately 1.7 percent, and that proposed changes in uncompensated care payments will increase IPPS operating payments by an additional 1.2 percent for a total increase in IPPS operating payments of 2.9 percent. In sum, CMS projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $3.1 billion in FY 2018.
Furthermore, for Medicare uncompensated care payments, CMS is proposing to begin incorporating uncompensated care cost data from Worksheet S-10 of the Medicare cost report. Specifically, for FY 2018, CMS proposes to use Worksheet S-10 data from FY 2014 cost reports in combination with insured low income days data from the two preceding cost reporting periods to determine the distribution of uncompensated care payments.
In the proposed rule, CMS also seeks public comment "on the appropriate role of physician-owned hospitals in the delivery system," as well as input on how the "scope of and restrictions on physician-owned hospitals affects healthcare delivery." CMS notes that it is "particularly interested" in comments on the impact on Medicare beneficiaries.
With respect to the Hospital-Acquired Conditions Reduction Program, CMS is proposing to make five changes to existing HAC Reduction Program policies: (1) specify the dates of the time period used to calculate hospital performance for the FY 2020 HAC Reduction Program; (2) request comments on additional measures for potential future adoption; (3) request comments on accounting for social risk factors; (4) request comments on accounting for disability and medical complexity in certain measures; and (5) update the Extraordinary Circumstance Exception policy.
CMS also proposes to revise the application and re-application process for national accrediting organizations (AOs), such as by requiring AOs to post provider/supplier survey reports and plans of corrections from CMS-approved accreditation programs on their website.
The proposed rule also addresses the hospital readmissions reduction program, clinical quality measures, the Medicare and Medicaid EHR incentive programs, and the LTCH quality reporting program, among other programs. For example, CMS is proposing a one year regulatory moratorium on the payment policy threshold for patient admissions in long-term care hospitals while CMS continues to evaluate long-term care hospital policies.
Additionally, CMS is issuing a request for information (RFI) for potential regulatory, sub-regulatory, policy, practice and procedural changes that address "improvements to the health care delivery system, how Medicare can contribute to making the delivery system less bureaucratic and complex, and how we can reduce burden for clinicians, providers and patients in a way that increases quality of care and decreases costs." In responding to the RFI, CMS states that it should be provided with clear and concise proposals that include data and specific examples.
Additional information can be found in the attached rule and the related Fact Sheet and press release. Comments are due by June 13, 2017.
Click here to read the fact sheet.
Congressional Health Events and Bills Introduced
Click here to view a chart of health care related Congressional events currently scheduled for the week of April 24-28, 2017.
The Centers for Medicare & Medicaid Services (CMS) released the February 2017 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report providing data on state Medicaid and Children's Health Insurance Program (CHIP) agency activity for the month.
CMS indicates that over 74 million individuals were enrolled in Medicaid and CHIP in the 51 states reporting February 2017 data - approximately 68 million enrolled in Medicaid and over 5 million enrolled in CHIP. CMS also indicates that almost 16.7 million additional individuals were enrolled in Medicaid and CHIP in February 2017 compared to the period prior to the start of the first Affordable Care Act open enrollment period (July - Sept. 2013), in the 49 states that reported relevant data for both periods. CMS notes that this represents a 29 percent increase over the baseline period.
Additional information can be found in the
report and explanatory information is available by
clicking here.
Medicine triumphs in fight against insurance mega-mergers
Once again, medicine's cohesive leadership gives us something to celebrate. In a landmark victory for patients and physicians, a federal appeals court has upheld the lower-court ruling blocking giant health insurance company Anthem's proposed acquisition of Cigna. The proposed merger would have given Anthem more power in contract negotiations with physicians and hospitals. It would have created an unacceptable monopoly - one that would have reduced your patients' choices and physicians' options.
The AMA and a 17-state medical society coalition worked together for nearly two years to guard against destructive oversteps from the insurance industry. Together, physicians won this important fight. We will continue to demonstrate physicians' strength as allies for our patients and custodians of our profession.
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