Final IPPS Rule Elicits Objections from Hospital Groups

Cheryl Clark, for HealthLeaders Media , August 5, 2013

"Also, the final rule demonstrates that CMS is unwilling to fundamentally change its rebilling policy. While they have extended the deadline for very few additional claims, such change will have little practical effect overall. We intend to proceed with our lawsuit."

Blair Childs, senior vice president for the Premier healthcare alliance, a 2,800-hospital group purchasing and quality organization, said his company is "deeply disappointed" in the new outpatient versus inpatient definition.

"While CMS's quest for clarity is admirable," Childs said in a prepared statement, "these new medical review and admissions criteria do not provide any protections from burdensome audits and appeals, and require providers to have a sixth sense and predict the future treatment needs for patients.

"Moreover, these changes add insult to injury, imposing an associated 0.2 percent payment reduction to offset what CMS believes will be an increase in inpatient volume. We expect that this will result in even more confusion around what constitutes an appropriate inpatient hospital admission, all while cutting payments for following CMS's rules."

Childs added that Premier is concerned that some of the measures to be included in the FY 2015 HAC reduction program duplicate measures outlined for FY 2016 and future years of the value-based purchasing program, such as rates of CAUTI and CLABSI.

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