Every year the Center for Medicare and Medicaid Services issues rules for the next fiscal year’s reimbursement policies and amounts for the various categories of providers. Recently the proposed rule for inpatient and long-term care hospital reimbursement was released for comment. (CMS Rule) Several hundred pages in length, the proposed rule covers changes in the MS-DRG classification system and relative weights; documentation and coding adjustments; charge compression, health care associated conditions; new technology add-on payments; the Hospital Inpatient Quality Reporting system and the associated Hospital Value-Based Purchasing initiative; and readmissions.
About 20 new MS-DRG classifications were added and 32 modified, primarily to increase hospitals’ ability to identify severity issues. As with the last couple of years, CMS continues to find extensive coding and documentation adjustments by hospitals under the new system, adjustments that don’t reflect real changes in patients’ treatment needs, so once again a significant cut in reimbursement results, for 2012 this will be a total of about 6.5%. Might create a negative return for hospitals on all that money they spend on outside firms to help them with those coding and documentation “adjustments”. Healthcare Acquired Conditions is another area of examination, with a new one added for contrast-induced kidney injury and the overall reporting scheme refined.
Many pages were devoted to the Hospital Inpatient Quality Reporting System and its associated program for Value-Based Purchasing. CMS is trying to avoid duplication in measures and reporting. CMS says it is trying to focus on actual patient outcomes and on patient experience in its measures. Eight measures are being retired for 2012, some because they have topped out and some because they don’t reflect the current state of the art in care. In future years, new measures will be added for health care associated infection and in regard to Medicare spending per beneficiary. Other topics being examined for new measures are stroke care and venous thromboemboli. CMS also said it is trying to minimize the administrative burden of quality reporting by moving away from chart abstraction to measures that can be collected automatically, especially from EHRs. The proposed rule is well worth at least a skim through.
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at 
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