FY 2013 IPPS Final Rule Released

On August 1, 2012, the Centers for Medicare and Medicaid Services (“CMS”) released the fiscal year (FY) 2013 Inpatient Prospective Payment System (“PPS”) Final Rule. The Rule contains several updates to Affordable Care Act (“ACA”) programs implemented in prior rule makings. The Rule also finalized the market basket update of 2.8% for IPPS hospitals. The following are programs meant to improve quality of care for patients:

  • Hospital Inpatient Quality Reporting (IQR) Program
  • Changes to the Value Based Purchasing (VBP) Program
  • Readmissions Reduction Program
  • Expiration of Certain Payment Rules to LTCHs & Moratorium
  • Hospital Acquired Condition Program

Hospital Inpatient Quality Reporting (IQR) Program
In the Rule, CMS proposes programmatic changes to the Hospital IQR program for the FY 2015 payment determination and subsequent years. The IQR program requires that IPPS hospitals successfully report on 55 measures in FY 2012, 57 in FY 2013, 55 in FY 2014, 59 in FY 2015, and 60 in FY 2016.

Providers that do not successfully report face a 2% reduction in their market basket update. For 2013, this means hospitals that fail to report will only see a 0.8% increase in their market basket.

The proposed changes are intended to reduce burdens on hospitals, create a more streamlined data set, and improve care generally through increased focus on various areas of hospital services. Notably, the Rule reduces the number of measures from 72 to 59 for the FY 2015, and 60 for the FY 2016 payment determination. More specifically, CMS removes one chart-abstracted measure and 16 claims-based measures.

Next week we will review the changes made to the Value Based Purchasing (VPB) Program.

Source: www.polsinelli.com; September 11, 2012.