Inpatient Prospective Payment System – FY 2016 Regulations
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Each year, the Centers for Medicare & Medicaid Services (CMS) sets forth regulations to determine payment for the operating costs of acute care hospital inpatient stays under Medicare Part A based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). When these regulations are published in the Federal Register, they also include prospective payment policies for long-term care hospitals, quality reporting requirements for providers, and other policy changes related to payment for acute care services under Medicare Part A.
CMS published a proposed rule for the FY 2016 IPPS and related policies on April 30, 2015. The comment period closed June 16, 2015. SHEA submitted comments in response to several provisions that impact SHEA members' practice settings and the patients they serve.
What does this mean?
Once CMS publishes a final rule, acute care hospitals and long-term acute care hospitals must adhere to the policies set forth in the final rule in order to be eligible to receive payment for care delivered to Medicare Part A beneficiaries. Payment for services is tied to the quality of care delivered to patients, which is evaluated using quality performance measures. Failure to meet or exceed care quality performance standards established by this regulation may result in penalties in the form of reimbursement rate reductions, or revocation of Medicare service provider eligibility.
Many of the quality measures included in the IPPS rule are related to prevention of healthcare-associated infections (HAIs) and other hospital-acquired conditions (HACs). Hospital epidemiologists are responsible for developing and overseeing strategies for preventing and reducing the number of HAIs within their patient population. The HAI-related performance measures fall into the domain of many SHEA members' responsibilities for reporting and evaluating infection rate data.
What has SHEA done on this issue to date?
SHEA commented on a number of sections in the IPPS proposed rule. SHEA's response was developed by the SHEA Public Policy and Government Affairs Committee. A summary of SHEA's comments are also available for quick reference. However reading SHEA's full comment document is strongly encouraged in order to fully understand our policy position on the various provisions of the proposed rule.
What will SHEA do next?
SHEA will continue to track the progress of this proposed regulation and work with other stakeholders to understand the impact of the policies promulgated in the final rule. Once the final rule is published, SHEA will develop a summary of the final provisions covered in SHEA's comments.
How can I get involved?
SHEA understands and appreciates your desire to stay informed and to get directly involved in SHEA's next steps. To receive regular updates and to receive instructions on how to get involved, join SHEA's Grassroots Network.