Late last week, the 2013 Inpatient Prospective Payment System (IPPS) Proposed Rule appeared in the May 11, 2012 edition of the Federal Register. This Proposed Rule intends to revise and update the Medicare hospital inpatient prospective payment system for acute care hospitals and for inpatient services provided by long-term care hospitals for fiscal year 2013. MCRA has reviewed the major changes and potential revisions and has provided a synopsis below. A more comprehensive analysis specifically detailing the Proposed Rule’s impact on the orthopedic industry is forthcoming.
The Center for Medicare and Medicaid Services (CMS) issued the FY 2013 Proposed Rule late last month; changes under the rule would be applicable to discharges occurring after October 12 of this year. This rule intends to modify and update the Medicare fee-for-service inpatient payment rates and policies and also continues to implement certain key provisions of the Patient Protection and Affordable Care Act (PPACA). Notable provisions of the rule include:
- Medicare payments to general acute care hospitals are projected to increase 0.9 percent, while hospitals that successfully participate in the Hospital Inpatient Quality Reporting Program would receive a 2.3 percent increase in payment from CMS. This latter figure accounts inflation, a statutorily mandated adjustment factor and increases related to coding changes and hospital documentation;
- Two new conditions may be added to CMS’s list of Hospital-Acquired Conditions (HACs), related to Surgical Site Infection. The first specifically relates to the implantation of a cardiac medical device: Surgical Site Infection following cardiac implantable electronic device (CEID). Under the HAC provision, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. Thus, if this proposed change is effected in the Final Rule, a Surgical Site Infection following the implantation of a CEID would be paid at the lower MS-DRG, as though this secondary diagnosis were not present.
- Additions and deletions to the “Complications and Comorbidities” and “Major Complications and Comorbidities” lists that may directly impact MS-DRG classification and associated reimbursement for certain orthopedic procedures.
- A proposed overall reduction in the number of Inpatient Quality Reporting (IQR) measures from 72 to 59 for fiscal year 2015, tempered by several additions to the Hospital IQR measures, including claims-based measures specific to total hip arthroplasty and total knee arthroplasty. The proposed measure assesses complications occurring after these two procedures from the date of the admission through 90 days post-admission.
- Updates to certain MS-DRG classifications and relative weights to better reflect treatment patterns, technology and utilization of hospital resources.
Again, the above provisions are merely highlights of the rule; a more detailed and direct analysis of the rule’s potential impact on the orthopedics industry will be posted to Orthopedic Intelligence shortly. Stakeholders and other members of the community with a vested interest in the final publication of this rule should strongly consider submitting comments during the stated comment period. To be assured consideration, comments must be received by June 25, 2012. Details as to appropriate methods of submission can be found in the May 11, 2012 issue of the Federal Register. The final rule is expected to be issued by CMS on August 1, 2012.