Hospitals failed to wring many changes from the Obama administration in the final version of Medicare's 2016 payment rule for inpatient care.
The CMS finalized widely panned proposals on new quality measures and site-neutral payments and declined to say whether the agency plans to extend the enforcement delay on the two-midnight rule governing short hospital stays.
The payment rule for the Inpatient Prospective Payment System, issued July 31, also lowers hospitals' rate increase for 2016 to 0.9% from the 1.1% increase proposed in April.
Hospitals criticized the draft version of the regulations for moving forward with several new quality measures that lack endorsement by the National Quality Forum.
“CMS continues to disregard its own rules to only implement quality measures that are endorsed by the NQF,” Catholic Health Initiatives said in comments on the proposed version of the rule. "NQF provides an extra layer of testing and reliability for quality measures used in health settings and is an important 'stamp of approval' before CMS uses a measure to determine hospital reimbursements or penalties.”
The CMS, however, said the measures fill gaps in available data on the resources hospitals are using to treat patients.
For instance, the CMS plans to survey hospitals on whether they survey patients about patient-safety culture and, if so, what tool they use.
“We were unable to identify any NQF-endorsed measures that assess a patient-safety culture, and found no other feasible and practical measures on this topic,” the CMS said in the final rule. “We also are not aware of any other measures that assess whether a hospital administers a survey on patient safety.”
The CMS has also declined to follow the industry's suggestion that electronic clinical quality measures be aligned with ones from the Joint Commission. “Several of the proposed electronic clinical quality measures … have been retired from the Joint Commission core measure set,” Kaiser Permanente said in a comment. “The lack of quality measure harmonization and alignment creates inefficiencies, diverts limited analytical and improvement resources from priorities, and sows confusion.”
The agency countered that it must focus on alignment with the CMS' policy goals, including alignment with other agency programs and quality reporting programs.
The CMS also finalized a new site-neutral policy for less intensive cases that's expected to yield a 4.6% reduction in payments to long-term care hospitals (LTCH) in fiscal 2016.
Under the policy change, LTCHs will be reimbursed at current long-term rates as long as the patient was discharged from a general acute care hospital and the patient's stay included at least three days in an intensive care unit or coronary care unit. The patient's discharge from an LTCH with a principal diagnosis relating to psychiatric or rehabilitation services may not be reimbursed under LTCH rates. Otherwise the facility will receive a site-neutral payment.
The agency acknowledged numerous concerns about the policy, including that it appears to hold providers accountable for events outside of the LTCH's control. For example, the acute hospital's discharge claim might contain a coding error and fail to indicate that the patient received ICU services for at least three days.
The Federation of American Hospitals called it “unreasonable” to hold LTCHs financially accountable for the coding practices of other providers “when data shows the multiple, competing coding challenges experienced by many hospitals.”
The CMS said such instances would be anomalies and the facility would be able to address them through Medicare administrative contractors.
The American Hospital Association, meanwhile, said it was dismayed that the final rule makes no mention of delaying enforcement of the two midnight rule. The current enforcement delay ends Sept. 30, and providers wanted a delay until Jan.1, 2016, so that it kicks in at the same time as other policy changes.
The CMS said it intends to address the two-midnight rule in the final version of the hospital outpatient prospective payment systems rule, which it expects to publish in November. The draft OPPS rule indicated the administration plans to modify the controversial policy, which sets parameters for whether short hospital stays should be billed as inpatient care or outpatient observation services.
