Ex­cep­tions are the rule

Hos­pi­tal pay­ment sys­tem full of ad­just­ments

Modern Healthcare - - LATE NEWS - Rich Daly

Congress’ non­par­ti­san in­ves­tiga­tive arm re­ported that 91% of hos­pi­tals paid by Medi­care re­ceive some dis­pen­sa­tion or add-on to the pro­gram’s stan­dard pay­ment sys­tem. The In­pa­tient Prospec­tive Pay­ment Sys­tem was de­signed to max­i­mize “cost-con­trol, ef­fi­ciency and ac­cess” when it was launched 30 years ago, ac­cord­ing to the Govern­ment Ac­count­abil­ity Of­fice re­port. But Congress has piled on an ac­cu­mu­lat­ing num­ber of ex­emp­tions and carve-outs for var­i­ous types of hos­pi­tals.

The agency’s other find­ings in­clude that 63% of hos­pi­tals qual­ify for at least one of four types of pay­ment in­creases; 28% of hos­pi­tals re­ceive an ex­emp­tion from IPPS through the crit­i­cal-ac­cess hos­pi­tal pro­gram; and Congress has en­acted 15 changes to boost pay­ments for var­i­ous groups of hos­pi­tals.

For nearly all hos­pi­tals, those tweaks have added up to pay­ments that ex­ceed Medi­care’s stan­dard rates. But some hos­pi­tals have ben­e­fited more than oth­ers. For in­stance, the GAO found 70 hos­pi­tals re­ceived four types of ad­di­tional pay­ments on top of the stan­dard Medi­care re­im­burse­ments.

The se­na­tors who re­quested the re­port said the find­ings sup­port the pre­vi­ous con­clu­sions of the In­sti­tute of Medicine and the Medi­care Pay­ment Ad­vi­sory Com­mis­sion that nu­mer­ous mod­i­fi­ca­tions to the pay­ment sys­tem have un­der­mined its in­tegrity. The wide­spread carve-outs, they said, in­di­cate that an over­haul is needed.

“It’s an­other in­di­ca­tor of the need to strengthen and im­prove Medi­care to bet­ter serve se­niors and tax­pay­ers,” Sen. Richard Burr (R-N.C.) said in a news re­lease.

The trade group for ru­ral hos­pi­tals— among the big­gest ben­e­fi­cia­ries of the mod­i­fi­ca­tions—coun­tered that the IPPS sys­tem was de­signed pri­mar­ily for high-vol­ume providers. “But in low-vol­ume en­vi­ron­ments, this is not an ap­pro­pri­ate mech­a­nism to en­sure that you are able to sus­tain or­ga­ni­za­tions to carry out their mis­sions,” said Brock Slabach, a se­nior vice pres­i­dent at the National Ru­ral Health As­so­ci­a­tion.

The changes to IPPS were needed af­ter nearly 400 hos­pi­tals—many of them ru­ral fa­cil­i­ties—closed be­tween 1983, when Congress launched the IPPS sys­tem, and 1995, Slabach said. “Th­ese are cor­rec­tions to a poorly de­signed sys­tem in the first place.”

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.