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CMS Proposes Payment Rule for Inpatient Rehab Facilities

Friday April 22, 2011
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The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Friday that would update Medicare payment policies and rates for inpatient rehabilitation facilities in Fiscal Year (FY) 2012.  

The rule proposes to increase payment rates under the IRF Prospective Payment System (PPS) by a projected 1.5%, an estimated $120 million nationwide. The projected update reflects a rebased and revised market basket specific to IRFs, inpatient psychiatric facilities and long-term care hospitals.

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 Affordable Care Act. 

“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.”

The proposed quality reporting system is aligned with the goals of the Partnership for Patients, a new public-private partnership that aims to improve the quality, safety, and affordability of healthcare for all Americans.  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 the Partnership has identified as important places to begin in efforts to reduce harms to patients. A possible 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. 

IRFs that do not submit quality data would see their payments reduced by 2% points beginning in FY 2014.  CMS anticipates adding measures for reporting in the future through rulemaking.  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 became public.

CMS will accept comments on the proposed rule until June 21, 2011, and will address all comments in a final rule to be issued by Aug. 1.


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