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CMS proposes policy and payment changes for rehab facilities

The Centers for Medicare and Medicaid Services has issued a proposed rule that would update Medicare payment policies and rates for inpatient rehabilitation facilities in fiscal year 2012. The rule would increase payment rates under the IRF Prospective Payment System by a projected 1.5 percent — an estimated $120 million nationwide.

According to CMS, the projected update reflects a rebased and revised market basket specific to IRFs, inpatient psychiatric facilities and long-term care hospitals – currently estimated at 2.8 percent for FY 2012, less a 1.3 percentage point reduction mandated by the Affordable Care Act.

The proposed rule, which would apply to more than 1,200 Medicare-participating IRFs, including approximately 200 freestanding IRFs and approximately 1,000 IRF units in acute care hospitals and critical access hospitals, seeks to establish a new quality reporting system authorized by the ACA. 

"The proposed rule would extend Medicare’s ongoing efforts to use its payments to encourage better care for beneficiaries who are treated in inpatient rehabilitation facilities," said CMS Administrator Donald Berwick, MD. "The measures IRFs would report under the proposed rule will pave the way for Medicare to work with IRFs to improve patient safety, prevent patients from picking up new illnesses during a hospitalization and provide well-coordinated person-and-family-centered care."

According to Berwick, the proposed quality reporting system is aligned with the goals of the Partnership for Patients, a new public-private partnership that will help improve the quality, safety and affordability of healthcare. Initially, IRFs would submit data on two quality measures – urinary catheter-associated urinary tract infection and pressure ulcers that are new or have worsened.

These proposed measures represent two of the nine conditions identified by the partnership as important places to begin in efforts to reduce harm to a patient, Berwick said. A third measure, currently under development, would address readmissions within 30 days to another inpatient stay, whether in an acute care hospital, rehabilitation facility or other setting, he said.

Under the proposed rule, IRFs that do not submit quality data would see their payments reduced by 2 percentage points beginning in fiscal 2014. CMS also plans to establish a process for making the measures data available to the public. As with other data published on the CMS website, IRFs choosing to report quality data would have an opportunity to review the data for accuracy before it becomes public.

CMS officials said they will accept comments on the proposed rule until June 21 and will address all comments in a final rule to be issued by August 1. 

The proposed rule is available online here.

[See also: Post Acute Medical to build two Texas rehab hospitals; Cambridge Realty Capital provides $2.16M HUD LEAN loan to refinance Illinois rehab center.]

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