/ en Fri, 25 Apr 2025 17:23:59 -0500 Mon, 24 Jun 19 14:13:06 -0500 /lettercomment/2019-06-24-aha-comments-cms-inpatient-pps-fy-2020-proposed-rule <p>AHA comments on the Centers for Medicare & Medicaid Services’ hospital inpatient prospective payment system proposed rule for fiscal year 2020. We are submitting separate comments on the agency’s proposed changes to the long-term care hospital PPS.</p> Mon, 24 Jun 2019 14:13:06 -0500 Hospital Readmission Reduction Program <p>The Centers for Medicare & Medicaid Services (CMS) April 23 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS proposed rule for fiscal year (FY) 2020. The rule affects inpatient PPS hospitals, critical access hospitals (CAHs), LTCHs and PPS-exempt cancer hospitals. A summary of the proposals related to inpatient PPS hospitals, CAHs and PPS-exempt cancer hospitals is attached. The AHA issued a separate advisory on proposals related to the LTCH PPS. Comments on the proposed rule are due to CMS by June 24. The final rule will be published on or around Aug. 1 and take effect Oct. 1.</p> <p><strong>Our Take:</strong><br /> We are pleased that CMS has increased the new technology add-on payment rate, including for CAR-T therapies. Hospitals and health systems have been taking on this financial burden to ensure access to these life-saving treatments for patients, and while this proposal is not a permanent solution, it will help in the short-term. We also are strongly supportive of the proposed 90-day reporting period for attestation for the Promoting Interoperability Programs, a move that will reduce regulatory burden on hospitals. In addition, the AHA appreciates CMS’s recognition of the wage index’s shortcomings. At the same time, improving wage index values for some hospitals – while much needed – by cutting payments to other hospitals, particularly when Medicare already pays far less than the cost of care, is problematic. CMS has the ability to provide needed relief to low-wage areas without penalizing high-wage areas.</p> <p><strong>Key Takeaways:</strong><br /> CMS proposes policies to:</p> <ul> <li>Increase inpatient PPS payments by 3.2 percent in FY 2020.</li> <li>Use a single year of uncompensated care data from Worksheet S-10 to determine the distribution of Disproportionate Share Hospital uncompensated care payments for FY 2020.</li> <li>Increase the new technology add-on payment from 50 percent to 65 percent of the marginal cost of the case.</li> <li>Increase the wage index values for those hospitals with a wage index below the 25th percentile and decrease the wage index values for those hospitals with a wage index above the 75th percentile.</li> <li>No longer include wage index data from urban hospitals that reclassify as rural when calculating each state’s rural floor.</li> <li>Implement a reporting period of a minimum of any continuous 90 days for the calendar year 2021 reporting period for the Promoting Interoperability Programs.</li> <li>Replace the claims-only hospital-wide readmission measure in the Inpatient Quality Reporting program with a hybrid hospital-wide all-cause readmissions measure.</li> </ul> Wed, 15 May 2019 11:08:13 -0500 Hospital Readmission Reduction Program <p>The Centers for Medicare & Medicaid Services (CMS) Aug. 2 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS final rule for fiscal year (FY) 2019. The rule affects inpatient PPS hospitals, critical access hospitals (CAHs), LTCHs and PPS-exempt cancer hospitals. The AHA will issue a separate advisory on finalized proposals related to the LTCH PPS. Provisions of the final rule will take effect Oct. 1.</p> <p>A summary of the provisions related to inpatient PPS hospitals, CAHs and PPS-exempt cancer hospitals is in the Regulatory Advisory below.</p> Thu, 23 Aug 2018 08:29:54 -0500 Hospital Readmission Reduction Program /letter/2018-06-25-aha-cms-re-hospital-inpatient-prospective-payment-system-proposed-rule-fy-2019 Mon, 25 Jun 2018 13:32:31 -0500 Hospital Readmission Reduction Program <p>The Centers for Medicare & Medicaid Services (CMS) April 24 released its fiscal year (FY) 2019 <a href="https://www.gpo.gov/fdsys/pkg/FR-2018-05-07/pdf/2018-08705.pdf" target="_blank">proposed rule</a> for the hospital inpatient and long-term care hospital (LTCH) prospective payment systems (PPS). The rule affects inpatient PPS hospitals, critical access hospitals (CAHs), LTCHs and PPS-exempt cancer hospitals. A summary of the proposals related to inpatient PPS hospitals, CAHs and PPS-exempt cancer hospitals is attached. The AHA will issue a separate advisory on proposals related to the LTCH PPS. Comments on the proposed rule are due to CMS by June 25. The final rule will be published on or around Aug. 1 and take effect Oct. 1.</p> <p>A detailed summary of the proposed rule follows in the Regulatory Advisory below.</p> Wed, 16 May 2018 12:44:51 -0500 Hospital Readmission Reduction Program <p>AHA has created a readmissions penalty calculator for hospital leaders to assess the impact of the Hospital Readmissions Reduction Program on their organizations. The calculator is designed so that you enter your hospital's CMS Certification Number; the calculator will then estimate your readmissions penalty, if applicable.</p> <p>The FY 2019 Proposed Rule calculator can be downloaded below.</p> Wed, 16 May 2018 11:07:19 -0500 Hospital Readmission Reduction Program Wed, 25 Apr 2018 15:35:25 -0500 Hospital Readmission Reduction Program /news/headline/2018-01-12-medpac-recommends-2019-payment-update-hospitals-no-pac-update <p>The Medicare Payment Advisory Commission yesterday recommended that Congress increase Medicare base payment rates for hospital inpatient and outpatient services by 1.25% in 2019, as provided under current law. In other voting, the commission recommended that the Health and Human Services Secretary implement a redesigned skilled nursing facility prospective payment system in 2019 and provide no payment update for SNFs in 2019 and 2020. For other post-acute settings, MedPAC recommended a 5% cut for inpatient rehabilitation facilities in 2020; no update for long-term care hospitals in 2020; a 5% cut for home health agencies in 2019 and a two-year rebasing of the HH payment system beginning in 2020. It also recommended a fiscal year 2019 payment reduction for all four post-acute settings by blending existing relative weights with those from its new post-acute care PPS prototype. Lastly, the commission recommended Congress replace the Merit-based Incentive Payment System for clinicians with a new voluntary value payment program based on population-based measures. The commission also discussed the initial analysis of a congressionally-mandated study examining the impact of the Hospital Readmissions Reduction Program, with a final report due to Congress in June 2018. In <a href="http://www.aha.org/advocacy-issues/letter/2018/180110-let-aha-med-pac.pdf">comments</a> submitted this week, AHA supported the hospital updates but voiced concerns with the PAC recommendations and called the MIPS proposal “premature and potentially unfeasible.”</p> Fri, 12 Jan 2018 16:29:33 -0600 Hospital Readmission Reduction Program /2017-12-11-reducing-readmissions <div class="outlineContent clearfix "> <div class="clearfix"> <h2><strong>Case Studies - Conference Calls</strong></h2> <ul> <li><a href="/advocacy-issues/mentalhealth/130507call.shtml">St. Louis Community Collaborative: Reduces Psychiatric Readmissions & Cuts Cost of Care</a></li> <li><a href="/advocacy-issues/mentalhealth/121030call.shtml">Reducing Psychiatric Readmissions with a CMHC Partnership: Learn from Parkview Hospital in Fort Wayne, IN</a></li> <li><a href="/advocacy-issues/mentalhealth/110629call.shtml">Reducing Avoidable Readmissions and Stress on the Emergency Department and Other Hospital Outpatient Departments</a></li> <li><a href="/advocacy-issues/mentalhealth/101215call.shtml">Reducing Avoidable Psychiatric Readmissions</a></li> <li><a href="/advocacy-issues/mentalhealth/100806call.shtml">Best Practices - Reducing Readmission Rate for Psychiatric Inpatients</a></li> </ul> <h2><strong>Additional Resources</strong></h2> <p>The Agency for Healthcare Research and Quality (AHRQ) report titled “<a href="http://mandrillapp.com/track/click/30057716/www.effectivehealthcare.ahrq.gov?p=eyJzIjoiRmFHSHRXb3JhUk1wZEdoOUs2NWhfRzBHeDFZIiwidiI6MSwicCI6IntcInVcIjozMDA1NzcxNixcInZcIjoxLFwidXJsXCI6XCJodHRwOlxcXC9cXFwvd3d3LmVmZmVjdGl2ZWhlYWx0aGNhcmUuYWhycS5nb3ZcXFwvc2VhcmNoLWZvci1ndWlkZXMtcmV2aWV3cy1hbmQtcmVwb3J0c1xcXC8_cGFnZWFjdGlvbj1kaXNwbGF5cHJvZHVjdCZwcm9kdWN0SUQ9MjA4MlwiLFwiaWRcIjpcIjc1MWYwMTVhOWQ5MDQ1NmZiOWZlNzFiYzkwYzE3N2ZhXCIsXCJ1cmxfaWRzXCI6W1wiOGQ1ZTM5OWEzYjZlNmIxMzg3MDM4MzYwOWI2NDdhMWFlMzY4NjZmY1wiXX0ifQ">Management Strategies to Reduce Psychiatric Readmissions</a>” (Technical Brief Number 21).</p> <p><a href="http://www.bu.edu/fammed/projectred/toolkit.html" target="_blank">Project RED (Re-Engineered Discharge) Toolkit</a></p> <p><a href="http://www.hret.org/care/projects/guide-to-reduce-readmissions.shtml">HPOE: Health Care Leader Action Guide</a></p> <p><a href="/research/reports/tw/11sep-tw-readmissions.pdf">Examining the Drivers of Readmissions and Reducing Unnecessary Readmissions for Better Patient Care</a></p> <p><a href="http://www.hpoe.org/resources/case-studies/1258">Timely Discharges and Reducing Readmissions</a></p> <p><a href="http://www.ijmijournal.com/article/S1386-5056(12)00219-5/abstract">Integrated Electronic Medical Records Help Reduce Psychiatric Readmissions</a></p> </div> <div class="ie"> </div> </div> Mon, 11 Dec 2017 00:00:00 -0600 Hospital Readmission Reduction Program <div class="outlineContent clearfix wide"> <div class="clearfix"> <p>AHA has created a readmissions penalty calculator for hospital leaders to assess the impact of the Hospital Readmissions Reduction Program on their organizations. The calculator is designed so that you enter your hospital's CMS Certification Number; the calculator will then estimate your readmissions penalty, if applicable.</p> <p>The FY 2019 and 2020 Final Rule calculators can be downloaded using the links below.</p> <p> </p> <table align="center" border="0" cellpadding="10" cellspacing="0" class="table" width="70%"> <tbody> <tr> <td valign="middle"> <p align="center"><br /> <a href="/system/files/media/file/2019/08/readmissions-penalty-calculator-fy-2020-inpatient-final-rule.xlsx"><strong>Download the FY 2020 Readmissions Penalty Calculator</strong></a><br /> Updated August 2019</p> <hr /> <p align="center"><a href="/system/files/media/file/2019/08/inpatient-pps-final-rule-fy-2020-regulatory-advisory.pdf"><strong>Advisory: Medicare Inpatient PPS:<br /> The Final Rule for FY 2020</strong></a><br /> August 19, 2019</p> <hr /> <p align="center"><a href="/system/files/media/file/2019/03/fy-2019-final-readmissions-calculator.xlsx"><strong>Download the FY 2019 Readmissions Penalty Calculator</strong></a><br /> Updated March 2019</p> </td> </tr> </tbody> </table> <hr /> <p>Other AHA Impact Calculators:</p> <p><a href="/toolkitsmethodology/2017-12-11-hospital-acquired-condition-hac-reduction-program-impact-calculator">Hospital-Acquired Conditions (HAC) Reduction Program</a></p> <p><a href="/toolkitsmethodology/2017-12-11-value-based-purchasing-program-impact-calculator">Hospital Value-based Purchasing Program</a></p> <p><a href="/toolkitsmethodology/2017-12-11-medicare-dsh-calculator">Medicare Operating Disproportionate Share Hospital Payments</a></p> </div> <div class="ie"> </div> </div> Mon, 11 Dec 2017 00:00:00 -0600 Hospital Readmission Reduction Program