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CMS Issues Proposed Rule to Improve Medicare

April 16, 2007
by root
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The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to improve the accuracy of Medicare's payment under the acute care hospital inpatient prospective payment system (IPPS), while providing incentives for hospitals to engage in quality improvement efforts.

The payment reforms include a proposal to restructure the inpatient diagnosis related groups (DRGs) to account more fully for the severity of the patient's condition. In addition, the proposed rule includes provisions to ensure that Medicare no longer pays hospitals for their additional costs of hospital-acquired conditions (including infections), and includes an expanded list of publicly reported quality measures. The rule would also reduce payment for a DRG involving the implantation of a device, when a hospital replaces a device and the replacement is supplied to the hospital at no or reduced cost.

According to CMS, the proposed rule will add five new quality measures. The five proposed measures include 30-day mortality for Medicare patients with pneumonia, and four additional measures relating to surgical care improvement.

Comments on the proposed rule will be accepted until June 12, 2007 and a final rule, to be effective on or after Oct. 1, will be published later in the summer.

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