Hospitals and physicians are criticizing the CMS for increasing the number of conditions for which Medicare will no longer reimburse under its final inpatient prospective payment system rule for 2009 published last week.
Its questionable whether the conditions are preventable, and how they are to be recorded as present-on-admission is unclear, said Beth Feldpush, senior associate director for policy at the American Hospital Association.
The original nonpayment policy beginning Oct. 1 included eight conditions the CMS has deemed preventable. The three additional conditions are: surgical-site infections following certain orthopedic and bariatric surgeries; certain manifestations of poor control of blood-sugar levels; and deep-vein thrombosis or pulmonary embolism following total knee and hip replacements. The original eight conditions are: foreign objects retained after surgery; air embolism; blood incompatibility; Stage III and IV pressure ulcers; falls and trauma; catheter-associated urinary-tract infection; vascular catheter-associated infection; and surgical-site infection after coronary-artery bypass graft.
But many of those conditions are not backed up by solid evidence to be completely preventable, according to J. James Rohack, a physician and president-elect of the American Medical Association.
The final rule also added 13 more quality measures that hospitals will be required to report on to receive full reimbursement.
The CMS also released final payment rules for acute inpatient care, skilled-nursing care and rehabilitation. The CMS will pay a 3.6% marketbasket rate increase for inpatient care. The skilled-nursing home lobby applauded officials for reversing a decision to cut $770 million in nursing home care in fiscal 2009 and more than $5 billion over five years. The CMS said Medicare payment rates to nursing homes will increase by $780 million next year.