The Centers for Medicare & Medicaid Services (CMS) released the 2014 IPPS Proposed Rule on April 26, 2013, proposing several payment revisions as a result of the Patient Protection and Affordable Care Act (PPACA).
Although the hospital industry has weathered difficult conditions in the past, widespread challenges continue to push change within the sector. Widely reported regulatory changes and the need to obtain operational and financial scale and scope in the health care industry have combined with other auxiliary issues to compound the need for further change within the sector
Regulated transactions with physicians are now common for hospitals. With the significant number of physician practice acquisitions and other affiliations, the number of regulated transactions with physicians has gone up exponentially
In the fiscal year 2013 Medicare inpatient prospective payment system (IPPS) final rule, the Centers for Medicare & Medicaid Services finalized which hospitals are subject to the Hospital Readmissions Reduction Program (HRRP), as well as what portion of the IPPS payment will be affected by the readmission adjustment factor. The impact on the diagnosis-related group (DRG) reimbursement will begin October 1, 2012, with the beginning of the federal fiscal year (FY). Studies show nearly one in five patients discharged are readmitted within 30 days, at a cost to the Medicare program of $15 billion per year. Beginning in October, hospitals with readmission rates higher than a certain threshold for the three conditions below will be penalized up to 1 percent of their aggregate base DRG rate. The penalty increases to a maximum of 2 percent in FY 2014 and 3 percent in FY 2015. In addition, the list of conditions measured increases in FY 2015
On June 22, 2012, the IRS issued proposed regulations regarding several additional requirements enacted by the Patient Protection & Affordable Care Act applicable to tax-exempt hospitals.
Payment Rate Updates CMS has proposed a 2.1 percent update to the federal operating standardized amount. This is based on a 3 percent market basket update, reduced by two factors mandated by the Patient Protection and Affordable Care Act (PPACA): a 0.8 percent economy wide productivity adjustment and an additional 0.1 percent reduction.
The Centers for Medicare & Medicaid Services (CMS) is accepting comments through June 25, 2012, on the proposed rule changes to the hospital inpatient prospective payment system (IPPS) for federal fiscal year (FY) 2013. The proposed rule identifies CMS’ changes to the annual payment policy updates for hospitals as well as revisions to the wage index, quality reporting requirements and value-based purchasing. The proposed Payment Rate Updates establish the FY 2013 operating standardized amount at $5,325.62, a 2.1 percent increase from prior year for those reporting quality data.
Under the Social Security Act , Medicaid Disproportionate Share Hospital (DSH) payments to hospitals cannot exceed the uncompensated cost of providing inpatient and outpatient hospital services to Medicaid-eligible and uninsured individuals. The 2008 DSH final rule required state reports and audits to ensure the appropriate use of DSH payments and compliance with the DSH limit imposed at Section 1923(g) of the Social Security Act .
Independent hospitals have successfully faced difficult circumstances in the past, but new challenges are pushing the hospital industry onto more difficult footing. Fundamental, long-term industry challenges, including competitive disadvantages in size and scale, limited access to capital and competition for and with physicians, have increased the need for independent hospitals to re-examine their operational and financial strengths and weaknesses
Recently issued IRS Notice 2011-52 addresses community health needs assessment (CHNA) requirements added to the Internal Revenue Code by the Patient Protection and Affordable Care Act (ACA). While CHNA requirements are not effective until tax years beginning after March 23, 2012, the IRS is issuing guidance for hospital organizations wishing to start the process now. Guidelines in the notice refer to any CHNA made widely available to the public and any implementation strategy adopted on or before a date six months after the IRS issues further guidance