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建议规则要点
及其潜在影响
额外的细节
建议的付款更新
- 绿皮书: 提议的2.8% payment increase for FY 2024 is estimated to boost hospital payments by $3.2024财年将达到30亿美元. 然而, CMS预计,2024财年医疗保险不成比例份额医院(DSH)和医疗保险无偿医疗支付估计减少1.15亿美元,将部分抵消这一影响. CMS also anticipates an additional $460 million decrease in payments for cases involving new medical technologies in FY 2024, as new technology add-on payments expire.
- 根据医院再入院减少计划(HRRP),再入院人数过多的医院将继续看到支付的额外减少. 在医院收购条件(HAC)削减计划下,表现最差的四分之一医院也将在2024财年减少1%的支付. 在医院基于价值的采购(VBP)计划下,对医院绩效的上下调整也将继续改变特定医院的支付水平.
- LTCH: For standard LTCH PPS payments (non–site neutral), CMS is proposing a 3.1% market basket update, reduced by a 0.2% productivity adjustment to result in a total update of 2.9%. 然而, when factoring in a projected 4.7% reduction in high-cost outlier payments as a percentage of total LTCH PPS standard payments, CMS estimates an overall decrease in aggregated payments for discharges paid the LTCH standard payment rate by 2.到2024财年,这一比例为5%,即5900万美元.
Proposed Coding and Coverage Changes
- NTAP计划: 在NTAP项目中, CMS建议要求尚未获得FDA市场授权的技术申请人在提交NTAP时向FDA提交完整且有效的市场授权申请. CMS is also proposing to move the FDA approval deadline from July 1 to May 1 beginning with applications in FY 2025. CMS认为,这一变化将提高提交的NTAP申请的完整性,并确保该机构能够充分分析申请和支持数据.
- New COVID-19 Treatments Add-On Payment (NCTAP) Program: In response to the planned end of the public health emergency in May 2023, CMS is clarifying that the NCTAP will expire. 具体地说, discharges involving eligible products would continue to be eligible for the add-on payment through September 30, 2023, and no NCTAP would be made beginning with discharges on or after October 1, 2023.
- Social Determinants of Health (SDOH) Diagnosis Coding: IPPS payment is based on use of hospital resources in the treatment of a patient based on severity of illness, 云顶集团的复杂性, 和/或资源消耗. Based on an analysis of resource use, CMS建议将描述无家可归的三个ICD-10-CM诊断代码的严重程度从非并发症或合并症(NonCC)改为并发症或合并症(CC),以承认这些病例的平均资源成本较高.
Proposed Quality Program Updates
- Hospital Inpatient Quality Reporting (IQR) Program: CMS is proposing the adoption of three new measures, the removal of three existing measures, and modification to three existing measures.
- CMS建议在电子临床质量措施(eCQM)清单中增加三项措施,医院可以自行选择,以满足eCQM报告要求. These would begin with the CY 2025 reporting period and include: 1) Hospital Harm: 新闻ure Injury, 2) Hospital Harm: Acute Kidney Injury, and 3) Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults.
- CMS建议取消以下三个指标:1)择期原发性全髋关节置换术和/或全膝关节置换术后医院级别风险标准化并发症发生率, beginning with the FY 2030 payment determination, 2) Medicare Spending per Beneficiary (MSPB), beginning with the FY 2028 payment determination, and 3) Elective Delivery Prior to 39 Completed Weeks’ Gestation (also known as PC-01), beginning with the FY 2026 payment determination.
- CMS提议修改两项措施,从2027财年的支付决定开始,包括医疗保险优势(MA)入院:1)全医院混合全因风险标准化死亡率, and 2) Hybrid Hospital-Wide All-Cause Readmission. 最后, CMS提议修改医疗人员中COVID-19疫苗接种(HCP)措施,要求人员与CDC对“最新”疫苗接种的定义保持一致, including primary and secondary doses. This modification would begin with the FY 2025 payment determination (quarter 4 CY 2023 reporting period).
- 医院VBP计划: CMS is proposing several modifications to existing measures and the adoption of one new measure. CMS is also proposing to add a health equity scoring adjustment to the program.
- CMS建议增加以下措施:严重脓毒症和感染性休克:安全领域的管理捆绑措施. This would begin with the FY 2026 program year.
- CMS is proposing to modify two measures: 1) MSPB Hospital measure, beginning with the FY 2028 program year (proposed changes include allowing readmissions to trigger new episodes), 2)择期原发性全髋关节置换术和/或全膝关节置换术后医院级别风险标准化并发症发生率, beginning with the FY 2030 program year (proposed changes include the addition of mechanical complication ICD-10 codes).
- In alignment with CMS’s continued focus on health equity, 该机构提议通过调整医院的总绩效评分(TPS),采用健康公平评分制度,以奖励对云顶集团不足人群的卓越护理。. 这将基于医院在VBP计划中的总体表现以及在医院接受同等资格待遇的个人的比例.
- 其他更新: CMS is also proposing additional minor updates, including modifications to programmatic language and definitions, to other IPPS programs such as the Promoting Interoperability Program, HAC减少计划, and the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program. CMS is not proposing any changes to the HRRP.
- Long-Term Care Hospital Quality Reporting Program (LTCH QRP): CMS is proposing the adoption of two new measures, 一项措施的更新, 并取消了两项措施. CMS is also proposing that starting in FY 2026, the data completion thresholds for LCDS[1] 增加数据项目,要求医院100%报告所提交的至少90%的评估的质量测量和评估数据(目前的要求为80%). 不符合这一要求的ltch将继续在其年度付款更新中减少2个百分点. 最后, CMS建议从2024年9月的医疗比较更新开始公开报告卫生信息措施的转移.
- CMS建议增加以下措施:1)COVID-19疫苗:更新的患者/居民百分比(患者/居民级COVID-19疫苗)措施, beginning with FY 2026 program year, and 2) Functional Discharge Score (DC Function) measure, beginning with FY 2025 program year.
- CMS is proposing to modify the COVID-19 Vaccination Coverage Among HCP measure, in alignment with the Hospital IQR and PCHQR Programs, beginning with the FY 2025 program year.
- CMS建议从2025财年开始取消以下两项措施:1)LTCH患者接受入院和出院功能评估的比例和解决功能问题的护理计划, 2) LTCH患者接受入院和出院功能评估并制定功能护理计划的百分比.
其他建议更改
- Physician-Owned Hospital Self-Referral Law: For hospitals to submit claims for services referred by a physician owner or investor, the hospital must satisfy exception requirements. 在这些要求中, CMS建议澄清可以申请扩建例外的医院以及所需的数据和信息. CMS is also proposing to reinstate program integrity restrictions for hospitals meeting criteria as “high Medicaid facilities.” These restrictions were previously removed in the CY 2021 OPPS/ASC final rule.
- 农村工资指数: CMS建议从2024财年开始,在计算农村工资指数时,将农村重新分类医院与地理上的农村医院同等对待.
- 索取资料:
- 安全网医院: CMS认为,安全网医院通过向保险不足的人提供云顶集团,在促进卫生公平方面发挥着关键作用, 没有保险, and those who may face other barriers to care. CMS is seeking public comment on the unique challenges faced by safety net hospitals, 他们所云顶集团的病人, and potential solutions to help these hospitals address these challenges.
- IQR计划措施: CMS正在征求关于可能纳入两项老年措施的意见:老年医院和老年外科结构措施.
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脚注
- 1.
LTCH连续性评估记录和评估(CARE)数据集(LCDS)是LTCH提供者根据LTCH QRP收集患者评估数据的评估工具.
出版于2023年4月12日