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CMS Issues Final Rules for Payment Systems for Long-Term Care & Acute Care Hospitals

The Centers for Medicare and Medicaid Services (CMS) has issued final rules for 2015 for inpatient prospective payment systems. A news release from the American Physical Therapy Association (APTA) reports that the final rules’ net effect for prospective payment systems for long-term care hospitals (LTCHs) and acute care hospitals will be to increase payment to LTCHs by 1.1% under the LTCH prospective payment system and to decrease payments to acute care hospitals paid under the inpatient prospective payment system (IPPS) by $756 million.

According to APTA, the rule also finalizes the use of five readmissions measures for assessing readmission penalties, incorporating methodology changes, and avoids making any final changes to the “2-midnight” policy or regarding policies for short stays. Other changes for scheduled for 2015 include the distribution of $7.65 billion in uncompensated care payments and hospitals in the top quartile for the rate of hospital-acquired conditions (HACs) will have their Medicare IPPS payments reduced by 1%.

In addition, CMS will assess hospitals’ readmission penalties using five readmissions measures endorsed by the National Quality Forum, including heart failure, heart attack, hip/knee arthroplasty, chronic obstructive pulmonary disease, and pneumonia. CMS also provides guidelines for implementing the provision of the Affordable Care Act that requires transparency in hospital charges. Under these guidelines, hospitals should either publish a list of their standard charges or their policies for allowing the public to view the charges in response to an inquiry, as indicated on the APTA news release.

The APTA news release notes that in addition to the changes for 2015, CMS has finalized the addition of two quality measures (“Functional Outcome Measure: Change in Mobility among LTCH Patients Requiring Ventilator Support” and “Percent of LTCH Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function”) related to function for the 2018 LTCH Quality Reporting Program.

[Source: APTA]