Quality-Related Proposals in the FY 2016 IPPS Proposed Regulations - McDermott+Consulting

Quality-Related Proposals in the FY 2016 IPPS Proposed Regulations

The proposed rule, released by the Centers for Medicare & Medicaid Services on April 17, 2015, includes changes to several key quality-related initiatives affecting acute care hospitals and long-term care hospitals.

On April 17, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and rates for services furnished under the Medicare Hospital Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 435 LTCHs, would affect discharges occurring on or after October 1, 2015.

The rule includes a number of changes to various quality-related initiatives. Proposed changes affect the following programs:
• Hospital Readmissions Reduction Program
• Hospital Value-Based Purchasing (VBP) Program
• Hospital Acquired Condition Reduction (HAC) Program
• Hospital Inpatient Quality Reporting (IQR) Program

Hospital Readmissions Reduction Program

In October 2012, CMS began reducing Medicare payments for IPPS hospitals with excess readmissions, pursuant to the Hospital Readmissions Reduction Program. Excess readmissions are measured by a ratio: a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, pneumonia, hip/knee replacement and chronic obstructive pulmonary disease (COPD) divided by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than 1 indicates excess readmissions. In previous rulemaking, CMS expanded the readmissions measures for FY 2017 and future years by adding a measure for patients readmitted following coronary artery bypass graft surgery.

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For more information, please contact Sheila Madhani at (202) 204-1459 or smadhani@mcdermottplus.com