- CMS finalized Medicare payment increases and policy changes for skilled-nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and hospices last Friday.
- The changes, proposed in April, will continue the push toward paying providers for value rather than the quantity of services provided with several new quality measures.
- Failure to submit the required quality data under CMS' reporting programs will result in a 2 percentage point reduction to their payments, according to the agency.
The administration's timeline for tying Medicare payments to quality of care in its shift away from the traditional fee-for-service (FFS) is ahead of schedule. As of this March, 30% of Medicare payments are tied to alternative payments models (APMs) though HHS intended to meet that goal by year's end.
The final rules for SNFs and IRFs, scheduled to be published on August 5 in the Federal Register, adopt four quality measures - three to measure resource use and one for medication reconciliation.
The new quality measures for SNFs and IRFs are:
- Medicare Spending Per Beneficiary - Post-Acute Care (PAC)
- Discharge to Community – PAC
- Potentially Preventable 30-Day Post-Discharge Readmission
- Drug Regimen Review Conducted with Follow-Up for Identified Issues
The rule for IRFs adopts one additional measure for FY 2018 - “Potentially Preventable within Stay Readmission for IRFs.” CMS will begin reporting IRF quality data this fall.
In addition, the value-based purchasing program for SNFs, which is required by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT), adopts a performance scoring methodology, provides feedback reports, and establishes performance standards as well as a baseline and performance periods.
“In many areas, we believe these are important changes aimed at advancing quality via the IMPACT Act and other new law,” American Health Care Association President and CEO Mark Parkinson told McKnight's. “In others, we wish a different outcome had occurred,” Parkinson added.
Under the updates, aggregate payments to skilled-nursing facilities (SNFs) are projected to increase by $920 million (2.4%) once the rule becomes effective on October 1. Inpatient rehabilitation facilities (IRFs) will see an increase of about $145 million (1.9%).
Payments to hospices for FY 2017 will increase by $350 million (2.1%). The cap amount for 2017, which ends on September 30, will be $28,404.99. In 2016, the cap amount was $27,820.75.
Hospices will be required to regularly collect survey data from January to December of CY 2017 for FY 2019 annual payments updates (APU) and from January to December of CY 2018 for FY 2020 APU.
CMS wants hospice care to adopt two new measures - one for assessing staff visits to patients and caregivers (Hospice Visits When Death is Imminent), and one for evaluating "the percentage of hospice patients who received care processes consistent with guidelines" (Hospice and Palliative Care Composite Process Measure).
The second measure will be based on the existing seven measures under the Hospice Quality Reporting Program: Pain screening, pain assessment, dyspnea screening, dyspnea treatment, patients treated with an opioid who are given a bowel regimen, treatment preferences and beliefs/values addressed.