House GOP floats hos­pi­tal-pay­ment re­form

Modern Healthcare - - NEWS - By Paul Demko

Health­care pol­icy watch­ers say a new House Repub­li­can pro­posal to over­haul the way that Medi­care pays hos­pi­tals for short stays sig­nals hope that the new GOP-led Congress may be will­ing to ad­dress com­plex health­care is­sues with thought­ful ap­proaches.

The pro­vi­sions of the dis­cus­sion draft from the House Ways and Means health sub­com­mit­tee could resur­face dur­ing Congress’ next ef­fort to re­peal and re­place Medi­care’s sus­tain­able growth-rate for­mula for pay­ing physi­cians, with the lat­est patch set to ex­pire at the end of March. That an­nual ex­er­cise has be­come a ve­hi­cle for other health­care pro­pos­als be­cause it’s vir­tu­ally guar­an­teed to move.

“This should be viewed as the lat­est step in the long-run­ning and very dif­fi­cult de­bate about how to deal with short stays at hos­pi­tals,” said Eric Zim­mer­man, prin­ci­pal at McDer­mott & Con­sult­ing.

The Ways and Means dis­cus­sion draft pro­poses a pay­ment sys­tem for hos­pi­tal stays that would be adopted for fis­cal 2020, blend­ing the cur­rent pay­ment sys­tems for in­pa­tient and out­pa­tient care to cre­ate a uni­fied sys­tem. In the in­terim, the CMS would develop a tran­si­tional per-diem pay­ment sys­tem for short hos­pi­tal stays. It also would place re­stric­tions on re­cov­ery au­dit con­trac­tor au­dits un­til the new pay­ment sys­tem could be adopted.

The draft also in­cludes other pro­pos­als that may be part of the health­care de­bate. One is a par­tial lift­ing of the mora­to­rium on ex­pan­sion of physi­cian-owned hos­pi­tals in­cluded in the Pa­tient Pro­tec­tion and Af­ford­able Care Act, sup­ported by Rep. Sam John­son (R-Texas). Another pro­posal by Rep. Diane Black (R-Tenn.) would es­tab­lish a na­tion­wide bun­dled-pay­ments pro­gram.

Ilisa Halpern Paul, pres­i­dent of Drinker Bid­dle’s District Pol­icy Group, said these other pro­pos­als are car­rots to bring mem­bers on board with the broader dis­cus­sion about over­haul­ing Medi­care hos­pi­tal pay­ments.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion said it was still study­ing the pro­posal. The Fed­er­a­tion of Amer­i­can Hos­pi­tals raised con­cerns about lift­ing the mora­to­rium on physi­cian-owned hos­pi­tals, which it said would bring back the per­ils of physi­cian self-re­fer­ral ar­range­ments.

Halpern Paul said it’s wel­come news that Repub­li­cans seem to be se­ri­ously en­gag­ing on the Medi­care hos­pi­tal pay­ment front. “It’s clear that a lot of thought and work went into the con­struc­tion of the bill,”she said.

“It’s clear that a lot of thought and work went into con­struc­tion of the bill.”

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