CMS releases final rule on Medicare payment systems
Posted on August 2, 2012 | No Comments
The Centers for Medicare & Medicaid Services (CMS) released a final rule yesterday which revises the Medicare hospital inpatient prospective payment systems (IPPS). The rule will increase inpatient hospital Medicare payments by about $2 billion and long-term care hospital payments by about $92 million in fiscal year 2013. The rule sets Medicare reimbursement rates for 440 long-term care hospitals.
The rule also address value-based purchasing under the Affordable Care Act (ACA) and includes provisions to strengthen a variety of quality reporting programs, such as the hospital value-based purchasing program.
- Private entities generally measure performance and make incentive payments at the physician-group level rather than at the individual-physician level. Physician organizations favor this approach.
- Private entities use nationally endorsed performance metrics and noted the need for a standardized set of metrics across all payers. Physician organizations concur that a standardized set of metrics would be less administratively complex.
- Most private entities in GAO's study provide financial incentives tied to meeting absolute benchmarks--fixed performance targets--or a combination of absolute benchmarks and performance improvement. Physician organizations prefer incentives tied to absolute benchmarks over those based on how physicians perform relative to their peers. Physician organizations also favored incentives that reward improvement because baseline levels of performance vary.
- While private entities' incentive payments vary in size and in method, private entities typically provide such payments within 7 months of the end of the performance measurement period. Physician organizations stated that financial incentives should be distributed soon after the measurement period to have the greatest effect on performance.