The CMS proposed a 3.2% increase in inpatient Medicare reimbursements in fiscal 2006 for hospitals that report data on 10 quality measures. Those that do not report the data will receive a 2.8% increase, as mandated by the Medicare Modernization Act.
In its proposed rule issued today, the CMS also said it would expand the number of DRGs subject to the post-acute-care transfer policy, which would result in lower payments to hospitals. Under the proposal, DRGs will be subject to the post-acute-care transfer policy if, among other things, the DRG has at least 2,000 post-acute-care transfer cases and at least 20% of the cases in the DRG are discharged to post-acute care. The proposed criteria would subject 223 DRGs to the post-acute-care transfer policy, up from 30 that are subject to it now, the CMS said.
The proposed rule also includes revisions to several DRGs to improve the accuracy of payment, including splitting spinal fusion DRGs to allow higher payment for cases based on the presence of conditions such as scoliosis, malignant neoplasm of the vertebra or pathologic fracture. The CMS also proposed a new separate DRG for revisions of hip and knee replacements and proposed replacing two DRGs related to coronary artery stent insertion with four new DRGs.
The proposed rule will be published in the May 5 Federal Register. Comments are being accepted until June 24, and a final rule is to be published by Aug. 1, the CMS said. The new payment rates and policies will become effective Oct. 1. -- by Tony Fong