Health Information Management

CMS continues shift to value over volume in 2016 IPPS final rule

HIM-HIPAA Insider, August 10, 2015

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CMS finalized changes to multiple quality measures in the fiscal year 2016 IPPS final rule, released July 31.
 
“The final rule includes policies that advance the vision and commitment to increasingly shift Medicare payments from volume to value,” says Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM trainer, director of CDI Quality Initiative for Huff DRG Review in Eads, Tennessee.
 
CMS finalized the addition of seven new measures to the Hospital Inpatient Quality Reporting (IQR) Program. In addition, the agency finalized changes to the pneumonia readmission measure as part of the Hospital Value-Based Purchasing (HVBP) Program and the Hospital Readmissions Reduction Program (HRRP).
 
CMS is not adding or removing any Hospital-Acquired Condition (HAC) categories for FY 2016. It estimates that 19.4% of all hospitals will be penalized with a 1% reduction in MS-DRG payments for all traditional Medicare discharges in FY 2016 due to Hospital-Acquired Condition Reduction Program (HACRP) performance.
 
CMS also addressed provider comments on its plan to expand the Bundled Payments for Care Improvement (BRCI) Initiative.
 
The BPCI Initiative is composed of four related payment models that link payments for multiple services received by Medicare beneficiaries during an episode of care into a bundled payment.
 
More than 75 stakeholders responded to CMS’ request for comments on the BPCI Initiative. While CMS stated it would consider these comments if it does expand the initiative, it provided only general topics addressed by the commenters.
 
CMS included a small discussion on short stays and the 2-midnight rule. CMS did not propose any changes to the 2-midnight rule in the 2016 IPPS proposed rule, but reminded stakeholders that it did address short stays in the 2016 OPPS proposed rule. Stakeholders have until August 31 to submit comments on the short stay proposals.
 
The IPPS final rule did not include an extension of the partial enforcement delay of the 2-midnight policy. The partial delay expires September 30.
 
An inspection copy of the final rule is available, and it will be published in the Federal Register August 17.

Read the full article by Michelle Leppert, CPC, on HCPro’s website
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