News: IPPS proposed rule expands VBP, increases IPPS payment

The proposed rule strengthens the Hospital Value-Based Purchasing (VBP) program which will adjust hospital payments beginning in FY 2013, and annually thereafter, based on how well hospitals perform or improve their performance on a set of quality measures. (For additional information read the article “Value-based purchasing presents new CDI opportunities” in the July 2011 issue of CDI Journal.)

 

The proposed rule would also add a measure regarding Medicare spending per beneficiary to the VBP program, which would affect payments beginning in FY 2015. Hospitals can access their sample VBP reports via QualityNet. (View the February 28, 2012 CMS slide presentation “Dry Run of the FY 2013 Hospital VBP program” for more information.)

 

“If the goal is to reward excellence, hospitals have to ensure that their coders are up to speed with appropriate identification of complications and with present-on-admission indicators as well as the over documentation issues that could lead to financial penalties,” says ACDIS Advisory Board member Robert S. Gold, MD, CEO of DCBA, Inc., in Atlanta. “CDI specialists have to be aware of the issues to be able to help with quality statistics related to core measures in order to reflect excellence of care.” 

 

CMS expects the FY 2013 proposed documentation and coding adjustment (DCA) to net an aggregate increase of 0.2%. The DCA was originally established at the time CMS implemented MS-DRGs. It was thought that due to the increased need for specificity, facilities would focus attention on improvements to documentation. This improved documentation would result in a coding shift not necessarily indicative that facilities were treating sicker patients, only that they were now able to capture that data better, CMS said. The last two years the DCA resulted in a payment offset of -2.0% and -2.9%, so an increase of even a slight margin may be welcome news for facilities.

 

Under the proposed rule, payment rates for hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) program would be increased by 2.3%. Those that do not successfully participate in the IQR Program would receive a 2.0% point reduction or a payment rate update of 0.3%.

CMS will accept comments on the proposed rule until June 25, and will respond to all comments in a final rule to be issued by August 1, 2012.

 

You can read the proposed rule at the Office of the Federal Register website here: