RESUMEN
The current policy environment for rehabilitation in skilled nursing facilities (SNFs) is complex and dynamic, and SNFs are facing the dual challenges of recent Medicare payment policy change that disproportionately impacts rehabilitation for older adults and the COVID-19 pandemic. This article introduces an adapted framework based on Donabedian's model for evaluating quality of care and applies it to decades of Medicare payment policy to provide a historical view of how payment policy changes have impacted rehabilitation processes and patient outcomes for Medicare beneficiaries in SNFs. This review demonstrates how SNF responses to Medicare payment policy have historically varied based on organizational factors, highlighting the importance of considering such organizational factors in monitoring policy response and patient outcomes. This historical perspective underscores the mixed success of previous Medicare policies impacting rehabilitation and patient outcomes for older adults receiving care in SNFs and can help in predicting SNF industry response to current and future Medicare policy changes.
Asunto(s)
Medicare/estadística & datos numéricos , Sistema de Pago Prospectivo/legislación & jurisprudencia , Rehabilitación/economía , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Anciano , COVID-19 , Humanos , Medicare/legislación & jurisprudencia , Pandemias , SARS-CoV-2 , Estados UnidosRESUMEN
Background Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. Methods and Results Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95-1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89-0.96), Western states (aOR, 0.89; 95% CI, 0.84-0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86-0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11-1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. Conclusions The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.
Asunto(s)
Hemorragia Cerebral/rehabilitación , Reforma de la Atención de Salud , Medicare , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Alta del Paciente/tendencias , Sistema de Pago Prospectivo , Centros de Rehabilitación/tendencias , Instituciones de Cuidados Especializados de Enfermería/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pacientes Internos , Masculino , Medicare/economía , Medicare/legislación & jurisprudencia , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud/legislación & jurisprudencia , Alta del Paciente/economía , Alta del Paciente/legislación & jurisprudencia , Formulación de Políticas , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Sistema de Registros , Centros de Rehabilitación/economía , Centros de Rehabilitación/legislación & jurisprudencia , Instituciones de Cuidados Especializados de Enfermería/economía , Instituciones de Cuidados Especializados de Enfermería/legislación & jurisprudencia , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
From electronic health records to quality reporting, today's physicians deal with plenty of distractions from patient care. Starting in 2021, hospital-employed physicians may find themselves adding another one: explaining to patients the difference between their hospital's multiple published prices for the same service.
Asunto(s)
Economía Hospitalaria/legislación & jurisprudencia , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/legislación & jurisprudencia , Costos de la Atención en Salud/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Registros Electrónicos de Salud , Humanos , Cobertura del Seguro/economíaRESUMEN
Appeals court denies "free speech" challenge to cancer center's debt-collection suit.
Asunto(s)
Centros Médicos Académicos/economía , Centros Médicos Académicos/legislación & jurisprudencia , Instituciones Oncológicas/economía , Instituciones Oncológicas/legislación & jurisprudencia , Planes de Aranceles por Servicios/economía , Planes de Aranceles por Servicios/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Benceno/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Humanos , Industria del Petróleo y GasRESUMEN
The widespread call to severely curb or end "surprise" medical bills prompted competing federal legislation during the summer and fall of 2019. The negotiations, maneuvering, and bill markups have continued into this year. Similar to a new Texas law governing state-regulated plans, federal proposals would ban balance billing and remove patients from having any role in out-of-network payment disputes. But with insurer-friendly language lurking in many of those proposals, Dr. Fleeger warns the impact of such legislation could go well beyond out-of-network payment.
Asunto(s)
Costos de la Atención en Salud , Sistema de Pago Prospectivo/legislación & jurisprudencia , Humanos , Texas , Estados UnidosAsunto(s)
Acreditación/legislación & jurisprudencia , Regulación Gubernamental , Legislación Hospitalaria , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Atención Subaguda/legislación & jurisprudencia , Femenino , Humanos , Tiempo de Internación/legislación & jurisprudencia , Medicare/economía , Cobertura de Afecciones Preexistentes , Estados UnidosAsunto(s)
Registros Electrónicos de Salud/legislación & jurisprudencia , Interoperabilidad de la Información en Salud/legislación & jurisprudencia , Revisión de Utilización de Seguros/legislación & jurisprudencia , Registro Médico Coordinado/métodos , Sistema de Pago Prospectivo/legislación & jurisprudencia , Humanos , Sistemas de Registros Médicos Computarizados/legislación & jurisprudencia , Calidad de la Atención de Salud/legislación & jurisprudencia , Reembolso de Incentivo/legislación & jurisprudencia , Estados UnidosAsunto(s)
Recursos en Salud/legislación & jurisprudencia , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/legislación & jurisprudencia , Medicare/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Ahorro de Costo , Recursos en Salud/economía , Humanos , Modelos Organizacionales , Sistema de Pago Prospectivo/legislación & jurisprudencia , Estados UnidosAsunto(s)
Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Reembolso de Incentivo/economía , Reembolso de Incentivo/legislación & jurisprudencia , Humanos , Medicare Access and CHIP Reauthorization Act of 2015 , Planes de Incentivos para los Médicos , Mecanismo de Reembolso/economía , Mecanismo de Reembolso/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule with comment period updates the home health prospective payment system (HH PPS) payment rates, including the national, standardized 60-day episode payment rates, the national per- visit rates, and the non-routine medical supply (NRS) conversion factor, effective for home health episodes of care ending on or after January 1, 2019. This rule also: Updates the HH PPS case-mix weights for calendar year (CY) 2019 using the most current, complete data available at the time of rulemaking; discusses our efforts to monitor the potential impacts of the rebasing adjustments that were implemented in CYs 2014 through 2017; finalizes a rebasing of the HH market basket (which includes a decrease in the labor-related share); finalizes the methodology used to determine rural add-on payments for CYs 2019 through 2022, as required by section 50208 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123) hereinafter referred to as the "BBA of 2018"; finalizes regulations text changes regarding certifying and recertifying patient eligibility for Medicare home health services; and finalizes the definition of "remote patient monitoring" and the recognition of the costs associated with it as allowable administrative costs. This rule also summarizes the case-mix methodology refinements for home health services beginning on or after January 1, 2020, which includes the elimination of therapy thresholds for payment and a change in the unit of payment from a 60-day episode to a 30-day period, as mandated by section 51001 of the Bipartisan Budget Act of 2018. This rule also finalizes changes to the Home Health Value-Based Purchasing (HHVBP) Model. In addition, with respect to the Home Health Quality Reporting Program, this rule discusses the Meaningful Measures Initiative; finalizes the removal of seven measures to further the priorities of this initiative; discusses social risk factors and provides an update on implementation efforts for certain provisions of the IMPACT Act; and finalizes a regulatory text change regarding OASIS data. For the home infusion therapy benefit, this rule finalizes health and safety standards that home infusion therapy suppliers must meet; finalizes an approval and oversight process for accrediting organizations (AOs) that accredit home infusion therapy suppliers; finalizes the implementation of temporary transitional payments for home infusion therapy services for CYs 2019 and 2020; and responds to the comments received regarding payment for home infusion therapy services for CY 2021 and subsequent years. Lastly, in this rule, we are finalizing only one of the two new requirements we proposed to implement in the regulations for the oversight of AOs that accredit Medicare-certified providers and suppliers. More specifically, for reasons set out more fully in the section X. of this final rule with comment period, we have decided not to finalize our proposal to require that all surveyors for AOs that accredit Medicare-certified providers and suppliers take the same relevant and program-specific CMS online surveyor training that the State Agency surveyors are required to take. However, we are finalizing our proposal to require that each AO must provide a written statement with their application to CMS, stating that if one of its fully accredited providers or suppliers, in good- standing, provides written notification that they wish to voluntarily withdraw from the AO's CMS-approved accreditation program, the AO must continue the provider or supplier's current accreditation until the effective date of withdrawal identified by the facility or the expiration date of the term of accreditation, whichever comes first.
Asunto(s)
Servicios de Atención de Salud a Domicilio/legislación & jurisprudencia , Medicaid/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Ajuste de Riesgo/legislación & jurisprudencia , Acreditación/legislación & jurisprudencia , Terapia de Infusión a Domicilio , Humanos , Calidad de la Atención de Salud/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new payment classes for oxygen and oxygen equipment are budget neutral; payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.
Asunto(s)
Equipo Médico Durable/economía , Tabla de Aranceles/economía , Tabla de Aranceles/legislación & jurisprudencia , Medicare/economía , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Diálisis Renal/economía , Propuestas de Licitación/economía , Propuestas de Licitación/legislación & jurisprudencia , Humanos , Estados UnidosRESUMEN
This rulemaking adopts as final, with changes, proposed amendments to VA's regulations governing payment of per diem to States for nursing home care, domiciliary care, and adult day health care for eligible veterans in State homes. This rulemaking reorganizes, updates, and clarifies State home regulations, authorizes greater flexibility in adult day health care programs, and establishes regulations regarding domiciliary care, with clarifications regarding the care that State homes must provide to veterans in domiciliaries.
Asunto(s)
Centros de Día para Mayores/economía , Servicios de Atención de Salud a Domicilio/economía , Casas de Salud/economía , Sistema de Pago Prospectivo/economía , Salud de los Veteranos/economía , Veteranos/legislación & jurisprudencia , Centros de Día para Mayores/legislación & jurisprudencia , Servicios de Atención de Salud a Domicilio/legislación & jurisprudencia , Humanos , Casas de Salud/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Gobierno Estatal , Estados Unidos , Salud de los Veteranos/legislación & jurisprudenciaRESUMEN
This document announces changes to the payment adjustment for low-volume hospitals under the hospital inpatient prospective payment systems (IPPS) for acute care hospitals for fiscal years (FYs) 2011 through 2017 in accordance with section 429 of the Consolidated Appropriations Act, 2018.
Asunto(s)
Economía Hospitalaria/legislación & jurisprudencia , Reembolso de Seguro de Salud/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Humanos , Pacientes Internos , Reembolso de Seguro de Salud/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Estados Unidos , United States Indian Health Service/economía , United States Indian Health Service/legislación & jurisprudenciaRESUMEN
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.
Asunto(s)
Economía Hospitalaria/legislación & jurisprudencia , Medicaid/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Registros Electrónicos de Salud , Interoperabilidad de la Información en Salud/economía , Interoperabilidad de la Información en Salud/legislación & jurisprudencia , Humanos , Revisión de Utilización de Seguros/economía , Revisión de Utilización de Seguros/legislación & jurisprudencia , Reembolso de Seguro de Salud , Medicaid/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/legislación & jurisprudencia , Reembolso de Incentivo/economía , Reembolso de Incentivo/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUGIV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary's SNF "resident" status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program.
Asunto(s)
Medicare/economía , Sistema de Pago Prospectivo/economía , Instituciones de Cuidados Especializados de Enfermería/economía , Compra Basada en Calidad/economía , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Humanos , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Instituciones de Cuidados Especializados de Enfermería/legislación & jurisprudencia , Estados Unidos , Compra Basada en Calidad/legislación & jurisprudenciaRESUMEN
This final rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2019. As required by the Social Security Act (the Act), this final rule includes the classification and weighting factors for the IRF prospective payment system's (PPS) case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2019. This final rule also alleviates administrative burden for IRFs by removing the Functional Independence Measure (FIM\TM\) instrument and associated Function Modifiers from the IRF Patient Assessment Instrument (IRF-PAI) beginning in FY 2020 and revises certain IRF coverage requirements to reduce the amount of required paperwork in the IRF setting beginning in FY 2019. Additionally, this final rule incorporates certain data items located in the Quality Indicators section of the IRF-PAI into the IRF case-mix classification system using analysis of 2 years of data beginning in FY 2020. For the IRF Quality Reporting Program (QRP), this final rule adopts a new measure removal factor, removes two measures from the IRF QRP measure set, and codifies a number of program requirements in our regulations.
Asunto(s)
Medicare/economía , Sistema de Pago Prospectivo/economía , Centros de Rehabilitación/economía , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Humanos , Pacientes Internos , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Centros de Rehabilitación/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule updates the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital. These changes are effective for IPF discharges occurring during the fiscal year (FY) beginning October 1, 2018 through September 30, 2019 (FY 2019). This final rule also updates the IPF labor-related share, the IPF wage index for FY 2019, and the International Classification of Diseases 10th Revision, Clinical Modification (ICD- 10-CM) codes for FY 2019. It also makes technical corrections to the IPF regulations, and updates quality measures and reporting requirements under the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program. In addition, it updates providers on the status of IPF PPS refinements.
Asunto(s)
Hospitales Psiquiátricos/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Grupos Diagnósticos Relacionados/economía , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Hospitales Psiquiátricos/legislación & jurisprudencia , Humanos , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule updates the hospice wage index, payment rates, and cap amount for fiscal year (FY) 2019. The rule also makes conforming regulations text changes to recognize physician assistants as designated hospice attending physicians effective January 1, 2019. Finally, the rule includes changes to the Hospice Quality Reporting Program.
Asunto(s)
Cuidados Paliativos al Final de la Vida/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Predicción , Cuidados Paliativos al Final de la Vida/legislación & jurisprudencia , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Cuidados Paliativos al Final de la Vida/tendencias , Humanos , Clasificación Internacional de Enfermedades , Medicare/legislación & jurisprudencia , Enfermeras Practicantes/economía , Enfermeras Practicantes/legislación & jurisprudencia , Asistentes Médicos/economía , Asistentes Médicos/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/legislación & jurisprudencia , Estados UnidosAsunto(s)
Costos de la Atención en Salud , Medicare/economía , Planes de Incentivos para los Médicos/economía , Sistema de Pago Prospectivo/economía , Reembolso de Incentivo/economía , Ahorro de Costo , Análisis Costo-Beneficio , Costos de la Atención en Salud/legislación & jurisprudencia , Costos de la Atención en Salud/normas , Gastos en Salud , Humanos , Medicare/legislación & jurisprudencia , Medicare/normas , Planes de Incentivos para los Médicos/legislación & jurisprudencia , Planes de Incentivos para los Médicos/normas , Formulación de Políticas , Sistema de Pago Prospectivo/legislación & jurisprudencia , Sistema de Pago Prospectivo/normas , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud/economía , Reembolso de Incentivo/legislación & jurisprudencia , Reembolso de Incentivo/normas , Estados UnidosRESUMEN
This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2018 to implement changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.