Though 2010’s payments are still in question, CMS released the proposed payment updates for acute and long-term care hospitals (LTCHs), reflecting positive and negative payments while introducing new reporting measures.

The FY 2011 inpatient prospective payment system (IPPS) does not reflect the Patient Protection and Affordable Care Act related provisions, CMS said, and will be applied to payments on and after Oct. 1, 2010.

Acute care hospitals, approximately 35,000 paid under IPPS, will experience a 2.4 percent increase due to inflation. Then an adjustment of -2.9 percentage points will be applied to recoup excess spending in FY 2008 and 2009.

CMS stated changes in hospital coding practices, that did not reflect patients’ severity of illness, was the over-spent culprit. The negative update brings FY 2011 IPPS payments for acute care hospitals to -0.1 percent.

LTCHs’ rates will increase by 2.4 percent due to inflation, but an adjustment of -2.5 percentage points will again be used to recoup over-spent federal dollars due to the same insufficient coding and billing.

With both updates configured, LTCHs’ payment rates for FY 2011 will increase by 0.8 percent, approximately affecting 420 LTCHs.

"The proposals we are announcing take a significant step towards improving the accuracy of Medicare payments for inpatient hospital stays, while continuing and expanding payment incentives to hospitals to improve the quality and safety of care they furnish to beneficiaries," said Jonathan Blum, deputy administrator and director for the Center for Medicare.

In efforts to promote quality care, hospitals must report quality measures included under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU). If hospitals are non-compliant with quality reporting they will receive the payment update, less 2 percentage points. In 2009, 96 percent of participating hospitals received the full update, CMS said.

The proposed rule will retire the mortality for selected surgical procedures composite, developed by the Agency for Healthcare Research and Quality, due to the agency stating that the measure is producing evidence gaps and shouldn’t be used for comparative reporting.

Open to public comment is 11 chart-abstract measures on the chopping block, they are:

• AMI-1: Aspirin at arrival
• AMI-3: ACEI/ARB for left ventricular systolic dysfunction
• AMI-4: Adult smoking cessation advice/counseling
• AMI-5: Beta-blocker prescribed at discharge
• HF-4: Adult smoking cessation advice/counseling
• PN-4: Adult smoking cessation advice/counseling
• SCIP-Infection-6: Surgery patients with appropriate hair removal
• HF-1: Discharge instructions
• PN-3b: Blood culture performed before first antibiotic received in hospital
• SCIP-Infection-2: Prophylactic antibiotic selection for surgical patients
• SCIP-Infection-4: Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose

Though comments are being recruited for measure retirement, CMS plans to add an additional 45 measures over time.

"In this FY 2011 rulemaking cycle, we are proposing an expansion to the RHQDAPU program that will take place over three payment years, and are proposing to add measures not only for the FY 2012 payment determination, but also for the FY 2013 and FY 2014 payment determinations," the Federal Register stated.

To be adopted for FY 2012 payment determination are eight hospital-acquired conditions. The reporting measures are claims based, so as not to add burden to hospitals’ administrative burden; they are:

• Foreign Object Retained After Surgery
• Air Embolism
• Blood Incompatibility
• Pressure Ulcer Stages III & IV
• Falls and Trauma: (Fracture, Dislocation, Intracranial Injury, Crushing, Injury, Burn, ElectricShock)
• Vascular Catheter-Associated Infection
• Catheter-Associated Urinary Tract Infection (UTI)
• Manifestations of Poor Glycemic Control

Another aspect of the proposed rule is the subject of accreditation for psychiatric hospitals, according to the Federal Register excerpt:

"Finally, we are proposing to offer psychiatric hospitals, hospitals with inpatient psychiatric programs, and psychiatric facilities that are not hospitals increased flexibility in obtaining accreditation to participate in the Medicaid program.

"Psychiatric hospitals would have the choice of meeting the existing regulatory requirements to participate in Medicare as a psychiatric hospital or to obtaining accreditation from a national accrediting organization whose psychiatric hospital accrediting program has been approved by CMS.

"Hospitals with inpatient psychiatric programs would have the choice of meeting the existing regulatory requirements for participation in Medicare as a hospital or obtaining accreditation from a national accrediting organization whose hospital accreditation program has been approved by CMS."

In addition, psychiatric facilities that are not hospitals would be afforded the flexibility in obtaining accreditation by a national accrediting organization whose program has been approved by CMS, or by any other accrediting organization with comparable standards that is recognized by the state.

For more information on the proposed payment updates visit the Federal Register at: http://edocket.access.gpo.gov/2010/2010-9163.htm.

Address: Centers for Medicare and Medicaid Services, 7500 Security Blvd., Baltimore, MD 21244; (877) 267-2323, www.cms.gov.

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