Pay boost

Con­necti­cut hos­pi­tals are the lat­est win­ners un­der ru­ral-floor rule

Modern Healthcare - - REGIONAL NEWS - Rich Daly

Con­necti­cut hos­pi­tals would win big un­der the CMS’ lat­est up­date of its con­tro­ver­sial ru­ral- floor pol­icy. The lat­est agency cal­cu­la­tions pro­ject hos­pi­tals in the state will see a $75 mil­lion boost in fis­cal 2014, com­pared with $16.7 mil­lion in the cur­rent fis­cal year, be­cause of a Medi­care pay­ment mod­i­fier based on ru­ral and ur­ban hos­pi­tal cat­e­go­riza­tions in each state.

The pay in­crease, in­cluded in a CMS pay­ment rule, would af­fect 27 of Con­necti­cut’s hos­pi­tals. The ad­di­tional funds stem from a fed­eral law that re­quires the CMS to pro­vide a wage in­dex for ur­ban hos­pi­tals at least equiv­a­lent to the wage in­dex for ru­ral hos­pi­tals in the same state.

The cal­cu­la­tion must be bud­get neu­tral, and the Pa­tient Pro­tec­tion and Af­ford­able Care Act re­quired national bud­get neu­tral­ity, which re­sulted in large in­creases or de­creases for some hos­pi­tals in cer­tain states.

The re­cent CMS rule did not pro­vide rea­sons for the ma­jor year-to-year swing in Con­necti­cut hos­pi­tals’ pay­ments, but a con­gres­sional source said it stemmed from the state’s hos­pi­tals sub­mit­ting in­com­plete or in­ac­cu­rate in­for­ma­tion last year, which the CMS used to cal­cu­late the fis­cal 2013 rates. Stephen Frayne, se­nior vice pres­i­dent of health pol­icy at the Con­necti­cut Hos­pi­tal As­so­ci­a­tion, blamed “bad data” for the rel­a­tively low fis­cal 2013 ru­ral floor-based pay­ments.

The in­crease for Mas­sachusetts and Con­necti­cut pow­ered a 4.4% over­all Medi­care boost for New Eng­land ur­ban hos­pi­tals un­der the rule, which dwarfed the 0.8% pro­posed in­crease for all acute­care hos­pi­tals next year. The statu­to­rily re­quired national bud­get neu­tral­ity means 434 hos­pi­tals— mostly clus­tered in the North­east—would garner ex­tra cash, while 2,970 other hos­pi­tals would face cuts, ac­cord­ing to the pro­posed rule.

The boost for Con­necti­cut hos­pi­tals was dwarfed by $169.1 mil­lion ex­tra that 60 Mas­sachusetts hos­pi­tals are ex­pected to re­ceive in the next fis­cal year be­cause of the ru­ral-floor pro­vi­sion. Al­though that is a drop from the $188 mil­lion the com­mon­wealth’s hos­pi­tals

gar­nered in the cur­rent fis­cal year, it still would boost the hos­pi­tals’ over­all Medi­care rates by 5.6%.

The Mas­sachusetts hos­pi­tals’ in­crease is the fo­cus of in­tense crit­i­cism of the pol­icy from hos­pi­tals on the los­ing side of it.

“It is un­fair to ma­nip­u­late the Medi­care pay­ment sys­tem to ben­e­fit one state’s hos­pi­tals at the ex­pense of all other states’ hos­pi­tals,” Sen. Tom Coburn (R-Okla.) said in a Se­nate floor speech in March.

The re­gional splits have led a 20-state coali­tion of hos­pi­tals to push leg­is­la­tion to elim­i­nate the statu­tory re­quire­ment for national bud­get neu­tral­ity. That mea­sure, spon­sored by Sen. Claire McCaskill (D-Mo.), has yet to ad­vance but a non­bind­ing bud­get amend­ment sup­port­ing such a move gar­nered broad bi­par­ti­san sup­port in March.

“This should give Congress fur­ther im­pe­tus to ad­dress this is­sue,” said Dan Bos­ton, a lob­by­ist lead­ing the hos­pi­tal coali­tion against the ru­ral floor pro­vi­sion.

Sup­port­ers of the cur­rent pol­icy have de­fended it as needed to cor­rect pre­vi­ous reg- ula­tory changes that dis­pro­por­tion­ately re­duced hos­pi­tal pay­ments to many of the hos­pi­tals now ben­e­fit­ting.

In­stead, some hos­pi­tal ad­vo­cates have sup­ported a com­pre­hen­sive over­haul of the hos­pi­tal wage in­dex, which could in­clude a res­o­lu­tion to the ru­ral-floor is­sue.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion is of­fi­cially neu­tral on the ru­ral-floor is­sue, ac­cord­ing to an of­fi­cial. The in­dus­try group es­tab­lished a task force in 2011 to look com­pre­hen­sively at wage in­dex is­sues and it was orig­i­nally plan­ning to is­sue a re­port last fall.

But in an April in­ter­view, Joanna Kim, vice pres­i­dent for pay­ment pol­icy at AHA, said that there is now no time­frame for such a rec­om­men­da­tion. “We’re still work­ing those rec­om­men­da­tions through the field to reach con­sen­sus,” she said.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.