Skilled-nurs­ing fa­cil­ity pay to be cut by 11.1%: CMS

Modern Healthcare - - Late News -

The CMS will cut Medi­care skilled-nurs­ing fa­cil­ity pay by 11.1%, or $3.87 bil­lion, in fis­cal 2012, a move strongly op­posed by the SNF in­dus­try (July 25, p. 14). The CMS cut the pay­ments to claw back es­ti­mated in­creased re­im­burse­ment in the cur­rent fis­cal year that re­sulted from un­in­tended changes in SNF Medi­care billing for ther­apy, which had fol­lowed changes in how Medi­care paid for ther­apy. The CMS in the rule said it has re­cal­i­brated its pay­ment struc­ture, en­acted through what it calls re­source uti­liza­tion groups, to cor­rect the in­cen­tives that led to billing for higher-cost ther­a­pies. They also tight­ened the rules for SNFs in the tim­ing of al­lo­cat­ing group ther­apy, to also re­duce fu­ture over­billing. “We be­lieve that any across-the-board cut is un­war­ranted and prob­lem­atic, and one of this mag­ni­tude is un­prece­dented,” said a state­ment from not-for-profit nurs­ing home as­so­ci­a­tion Lead­ingAge. The fis­cal 2012 re­cal­i­bra­tion re­duced pay­ments by $4.47 bil­lion, or 12.6%, but that change was par­tially off­set by the up­date of 1.7%, or $600 mil­lion, ac­cord­ing to the CMS. The up­date re­flects a 2.7% in­fla­tion in­crease and was re­duced by 1% through a pro­duc­tiv­ity ad­just­ment man­dated by last year’s Pa­tient Pro­tec­tion and Affordable Care Act. In a sep­a­rate fi­nal rule, the CMS in­creased pay­ments for in­pa­tient re­ha­bil­i­ta­tion fac­ul­ties in fis­cal 2012 by 2.2%, or $150 mil­lion, and also es­tab­lished a new qual­ity re­port­ing sys­tem. Wick­lund said in the re­lease, de­scrib­ing the de­ci­sion as “dif­fi­cult but es­sen­tial.” The job cuts are part of a broader plan—which also in­cludes physi­cian part­ner­ships and de­vel­op­ment of core ser­vice lines—to cope with the weak econ­omy and the de­mands of health­care re­form, ac­cord­ing to the re­lease. The 376-bed hos­pi­tal is part of not­for-profit Ex­em­pla Health­care, a two-hos­pi­tal sys­tem based in Den­ver and spon­sored by Sis­ters of Char­ity of Leavenworth Health Sys­tem, Lenexa, Kan. Lutheran Med­i­cal Cen­ter fin­ished 2009 with $7.8 mil­lion in in­come on $597.8 mil­lion in rev­enue.

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