Pro­posed rules would raise rates, cut doc re­im­burse­ment

Modern Healthcare - - Late News -

The CMS is­sued pro­posed Medi­care rules that would in­crease hos­pi­tal out­pa­tient rates by 1.5%, in­crease am­bu­la­tory sur­gi­cal cen­ter pay­ments by 0.9%, and de­crease physi­cian re­im­burse­ment by 29.5%, with the cut com­ing as a re­sult of pre­vi­ous de­lays of man­dated cuts tied to the sus­tain­able growth-rate for­mula. The pro­posed rule in­creas­ing pay­ments for care be­gin­ning Jan­uary 1, 2012, also would amend the Hos­pi­tal Value-Based Pur­chas­ing pro­gram to add a clin­i­cal process of care mea­sure to guard against in­fec­tions from uri­nary catheters. The pro­posal also would es­tab­lish per­for­mance pe­ri­ods, stan­dards and a “weight­ing scheme” for the fis­cal 2014 hos­pi­tal pro­gram. The value-based pur­chas­ing pro­gram, es­tab­lished un­der a fi­nal rule is­sued in April, will tie a por­tion of a hos­pi­tal’s pay­ment for in­pa­tient stays to its per­for­mance score on a set of qual­ity mea­sures. An­other com­po­nent of the pro­posed rule would es­tab­lish a process for cer­tain physi­cian-owned hos­pi­tals to ap­ply for an ex­cep­tion to the Pa­tient Pro­tec­tion and Affordable Care Act’s ban on ca­pac­ity ex­pan­sions at such fa­cil­i­ties. The pro­posed rule also would amend the Medi­care Elec­tronic Health Record In­cen­tive Pro­gram to al­low el­i­gi­ble hos­pi­tals and crit­i­cal-ac­cess hos­pi­tals to be­gin re­port­ing clin­i­cal qual­ity mea­sures in 2012 through an elec­tronic re­port­ing pilot. The pro­posed rule also would es­tab­lish a first-time qual­ity re­port­ing pro­gram for ASCs un­der the Hos­pi­tal Out­pa­tient Qual­ity Re­port­ing Pro­gram.

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