In August, CMS published the final Medicare Inpatient Prospective Payment rule for the federal fiscal year 2024. Most changes announced in the proposed rule were adopted and several are significant, including: Disproportionate Share Hospitals payment cuts; and a Rural Wage Index recalculation with diverse impacts. In this blog, we’ll cover these updates, the IPPS rule's total payment increase and how CMS continues to prioritize health equity in its rulemaking. The most significant IPPS final rule impacts 1. DSH UCC pool payment cuts For FFY 2024, DSH uncompensated care pool payments will decrease by $595 million due to decreased funding projections and a big adjustment to Factor 2 (see below), even though the DSH methodology is the same. This means DSH hospitals will need to find a way to recoup these losses, a challenge given the disadvantaged areas where they operate. If Affordable Care Act Marketplace plan enrollment continues to increase, Factor 2 cuts will continue. DSH UCC...

Data is at the heart of a Community Health Assessment . CHAs exist to collect community input, use that feedback to identify unmet needs and intervene effectively. A CHA cannot be fully effective without accurate, community-focused data. But these data are not easy for public health departments to locate, acquire, format or interpret — even if it comes from a single, reliable source. CHA data must be high-volume, high-quality and diverse. That takes time, staff and expertise which are often in short supply at public health departments. Faced with this daunting effort, health departments may rush past data to intervention, which could be a costly mistake. They may lose sight of the CHA's purpose beyond accreditation, make incorrect assumptions about community needs and ignore better resources. While data may be the most difficult CHA step, there are three ways you can help minimize the complexity. Overcome CHA data collection challenges 1. Remember why it matters Improved community ...

Assessing the needs of a community — through preparation, coordination and implementation — does more than check a box. It provides hospitals with insight into where time, money and resources should be dedicated to improve population health. This is the purpose of the Community Health Needs Assessment. A CHNA includes multiple moving parts and contributors who: interview community leaders; hold stakeholder meetings; conduct patient surveys and query results; establish and participate in community focus groups; and analyze population health metadata. These steps can be time-consuming and unclear, leaving many to question whether they’re accurately evaluating their community’s needs — or just trying to meet compliance requirements. But, what if there’s a better way? In this blog, we’ll break down three steps you can use to simplify your CHNA, so you can drive the best outcomes for patients and providers. Three ways to simplify the CHNA 1. Prepare Not-for-profit hospitals must conduct...

CMS’ proposed Calendar Year 2024 Medicare Home Health Prospective Payment System rule includes updates to: the Patient-Driven Groupings Model, Low Utilization Payment Adjustment thresholds, functional levels and comorbidity adjustment subgroups; estimated aggregate payments based on the 30-day payment rate to account for assumed versus actual behavior changes; the HH Value-Based Purchasing and Quality Reporting programs; home intravenous immune globulin items and services, and disposable negative pressure wound therapy device payment rates; medical equipment and supplies, including competitive bidding, as outlined by the Consolidated Appropriations Act of 2023; and provider and supplier enrollment requirements and oversight. The HH PPS rule also proposes to add a new Special Focus Program for low-performing hospices. CMS estimates that the rule will cut aggregate HH agency payments by $375 million nationally. This includes a -1.81% adjustment in the HH annual standard payment rate. Th...

CMS released important updates for Model Year 7 of Bundled Payments for Care Improvement Advanced. Providers who applied and have been accepted into the third cohort will soon begin the baseline evaluation and episode selection process. In this blog, we’ll cover important upcoming BPCIA dates and what you need to know now and for the future. Important upcoming CMS BPCIA dates Here are important BPCIA dates you’ll want on your radar in the coming months: September 2023 : At the beginning of the month, CMS will upload preliminary BPCIA Model Year 7 episode target prices and baseline episode and claims data on the CMS Enterprise Portal. As a provider, you will need to use these data to evaluate which clinical episode service line groups you want to participate in during the new model year. Dec. 4, 2023 : Providers who choose to move forward in the model have until this date to submit their MY7 Participation Agreement and Participant Profile, which will indicate selected episode initiators...

The healthcare industry has seen considerable government policy changes over the years that significantly impact patients and providers alike. A recent proposed change is the Medicare Outpatient Prospective Payment System Remedy for 340B Drug Payment Policy proposed rule . Issued in response to the U.S. Supreme Court’s decision on American Hospital Association v. Becerra , the 340B proposed remedy rule would provide 340B hospitals that were improperly underpaid during calendar years 2018 through 2022 with a one-time lump sum payment. This blog post will delve into the proposed rule, the potential impact of changes that providers could face and what 340B hospitals can expect in terms of remedy payments. How the 340B proposed rule changes would impact providers Payment reduction The proposed rule includes significant changes that would impact providers. First is the estimated annual payment reduction to offset the 3.19% rate increase in calendar year 2018. This proposed change would res...

DOH has released more details about actions hospitals must take under its Statewide Planning and Research Cooperative System injury, cause and place remediation project . The project was necessitated by a grant-funded study underway at DOH. SPARCS updated its edit rules to ensure injury, cause and place diagnosis codes between 2016 and 2023 are aligned to support the data integrity of the grant-funded study. As a result, New York state hospitals must resubmit inpatient and emergency department claims that fail these updated edit rules. Since the April 27 announcement of this project, HANYS has advocated on behalf of the state’s hospitals, bringing attention to the project’s workforce and financial implications. In addition, the DOH six-year data retention requirement and electronic health record changes have left some facilities lacking the data requested by the state. HANYS strongly encouraged SPARCS to enforce the new edit requirements only moving forward, to mitigate the challenges ...