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CMS Proposes Payment Changes for Inpatient Hospital Services |
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Wednesday, 26 April 2006 |
On April 25, the Centers for Medicare and Medicaid Services (CMS) published a notice of proposed rule making that will significantly change the way the agency develops payment policies under the Inpatient Hospital Prospective Payment System (PPS). The proposed rule can be viewed at: http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/cms1488p.pdf.
If implemented as proposed, the new payment methodology would revise payment rates for inpatient stays to be based on DRGs weighed on hospital costs versus hospital charges, and also would be adjusted to reflect the severity of the patient’s condition.
According to CMS, the proposed changes reflect congressional concerns
that the existing system creates incentives for certain specialty
hospitals to “cherry-pick” more profitable cases.
CMS stated the agency is considering a two-step process to
implementation the new payment system. The first step, with an
effective date of October 1, 2006, is to assign weights to DRGs based
on hospital costs. The second step, schedule for fiscal year 2008,
would replace the current DRGs with either severity adjusted DRGs or an
alternative developed in response to public comment.
CMS will accept comments on the proposed rule until June 12, 2006. It
is anticipated that the final rule will be published later this year.
For more information on the proposed rule, please contact Ingrida
Lusis, ASHA’s Director of Health Care Regulatory Advocacy, at
reimbursement@asha.org.
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