CMS’ 2015 IPPS proposed rule, released April 30, focuses on quality measures, such as the hospital-acquired condition (HAC) reduction, readmissions reduction, and hospital value-based purchasing and hospital readmissions reduction programs.
The rule does not contain any changes to the 2-midnight rule. However, CMS is asking for input on an alternative payment methodology for short stay inpatient cases that also may be treated on an outpatient basis, including how to define short stay.
CMS is proposing to reduce payments for hospitals with the highest rate of HACs by 1% to comply with the Affordable Care Act (ACA). The reduction will apply to the bottom 25% of hospitals (those with the worst HAC rates).
In addition, CMS proposes increasing the maximum payment reduction for hospital readmissions from 2% to 3%, also to comply with the ACA. CMS proposes to assess hospitals’ readmissions penalties using five readmissions measures endorsed by the National Quality Forum.
CMS also proposes changes to the Hospital Inpatient Quality Reporting (IQR) Program.
The proposed rule would increase IPPS operating payment rates by 1.3% after reductions, including a 0.8% coding and documentation reduction. CMS estimates Medicare payments to inpatient facilities will decrease by $241 million in Fiscal Year 2015.