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News of the Day ... In Perspective12/17/2007
Medicare changing rules for hospital payments
To overcome physicians� and hospitals� opposition to Medicare, the program�s congressional architects made certain promises. As explained by Dr. Meredith B. Rosenthal of the Harvard School of Public Health, they �selected payment mechanisms designed to preserve the status quo� (N Engl J Med 2007;357:1573-1575).
As Medicare�s costs become �untenable,� a series of congressional steps have �rendered Medicare�s payment policy far less passive than it once was.� The latest step is �nonpayment for performance.�
CMS will no longer be paying extra for certain complications deemed to be �preventable,� unless documented to be present on admission. Some hospitals are responding by increased surveillance and documentation of admission findings, as of decubitus ulcers. Some are doing universal screening for methicillin-resistant Staphylococcus aureus (MRSA) to avoid having to treat the infection without payment if it is only discovered after symptoms occur.
Doctors may be urged to document more specifically�say �left ventricular systolic dysfunction� rather than simple �congestive heart failure��to increase the DRG payment by thousands or tens of thousands of dollars.
Enhanced system gaming may be necessary for survival: a CMS report to Congress on Nov 26 proposes to cut Medicare payments to all facilities by a flat 2% to 5%. The money could be redistributed to hospitals as an incentive to meet certain criteria. This so-called value-based pricing, which requires congressional approval to implement, is designed to be cost-neutral to the government. It could save money if Congress decides not to redistribute all the withheld cash (Wall St J 11/27/07).
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