3 reimbursement changes for hospital performance

Hospitals are bracing themselves for some significant reimbursement changes under health reform that could hit their pocketbooks. The American Hospital Association (AHA) outlined top issues in its 2012 advocacy papers, including how hospitals will be measured for performance this year and beyond.

Value-based purchasing (VBP) - October 2012
Medicare will launch the hospital VBP program, in which pay-for-performance programs will receive incentives for demonstrated excellence and improvements in patient safety and effective care. The Centers for Medicare & Medicaid Services released the final rule in August last year. The AHA had serious concerns about CMS' proposal to include hospital-acquired conditions measures because a separate HAC provision would penalize hospitals, as well as the weighting of patient experiences. CMS will likely propose additional measures over the next several years, AHA said, with certain measures retiring when hospitals reach the maximum performance, that is, when hospitals can improve no further.

Readmissions - October 1, 2012 (FY 2013)
Under the Affordable Care Act provision, hospitals will face penalties for excess readmissions for heart attack, heart failure and pneumonia, starting in October. CMS did account for planned readmissions from heart surgeries following a heart attack, based on the AHA's urging.

The AHA also is pushing the agency to include community factors that could affect readmission reimbursements, which, "thus far, CMS has refused to account for," the association said.

"CMS needs to recognize that readmissions are the result of many factors, some are within a hospital's control, and some are related to the lack of resources elsewhere in the community, such as adequate numbers of primary care clinicians and access to pharmacies," AHA said. "There is compelling evidence that safety-net hospitals and others serving large numbers of low-income individuals will have difficulty reducing readmissions due to the lack of some of these resources in the communities they serve. This creates an unfair system that puts these hospitals at greater risk for substantial readmission penalties."

Hospital-acquired conditions - FY 2015
Hospitals also will face Medicare penalties for hospital-acquired conditions, starting in fiscal year 2015. Those that do well in the top quartile of national rates will receive 99 percent of their Medicare payments for all discharges. Some hospitals, however, will face penalties each year if they fail to progress--a position that AHA strongly opposes.

AHA stated, "Provisions from the Patient Protection and Affordable Care Act (ACA) must be implemented in a way that is fair and equitable for hospitals while seeking to avoid adverse unintended consequences."

However, an American Journal of Infection Control study this week found that CMS-issued penalties from 2008 did boost infection-control efforts, in which infection preventionists reported increased focus on stopping catheter-associated urinary tract and central line-associated bloodstream infections.

For more information:
- check out the AHA issue papers, including the hospital performance paper (.pdf)
- here's the AHA News Now brief

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