FY 2005 Medicare Inpatient PPS
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Related Resources
AAMC Documents
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Current Status
In the August 11, 2004 Federal Register the Centers for Medicare
and Medicaid Services (CMS) published
the final rule updating the Medicare inpatient prospective payment
system (PPS) for federal fiscal year 2005. The AAMC has prepared
a summary
and analysis (PDF, 28 pages - 159 KB) of the August 11
final rule.
The final rule provides extensive information on the implementation
process for the resident limit redistribution program mandated by
last year's Medicare Modernization Act (MMA). In brief, under this
program, hospitals that are not fully "using" their Medicare resident
caps will have those caps permanently reduced and the cap slots
will be "redistributed" to those teaching hospitals that can demonstrate
a need for them. The final rule addresses criteria to determine
which hospitals will lose resident cap slots as well as sets forth
the application process for hospitals seeking to increase their
resident caps. With limited exception, applications to receive additional
cap slots are due to CMS by Dec. 1, 2004.
The final rule also states that that the "initial residency period
(IRP)" determinations for residents training in specialties requiring
a first year broad-based training program, such as radiology, dermatology,
and anesthesiology, will be determined by that specialty, rather
than the specialty in which the resident meets the broad-based requirement,
if the resident "simultaneously matches" to both programs. IRPs
are used, in part, to determine Medicare direct GME payments. Under
the final rule, residents who simultaneously match will receive
longer IRPs since their residency durations are longer than the
duration of internal medicine, which often is the residency program
used to fulfill the broad-based requirement.
In other areas, the final rule:
- Increases the standardized amounts for hospitals that submit
data on 10 designated quality measures by 3.3 percent (a full
market basket (MB) update). All other hospitals will receive an
increase of 2.9 percent (MB- 0.4 percentage points);
- Sets an outlier payment threshold of $25,800, down from the
current threshold level of $31,000;
- Implements new metropolitan statistical area (MSA) definitions,
which affect the wage index value hospitals are assigned, and
provides a one-year transition for hospitals adversely affected
by changes in MSA determinations; and
- Incorporates an "occupational mix adjustment" into the wage
index determinations; and
- Provides special payments for four new medical services and
technologies.
Final Rule
The final rule published in the August 11, 2004 Federal Register
is available in one part in text format and Portable Document Format
(PDF)
- Part I [pp.48915–49782]: Text
/ PDF
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Contacts
Karen Fisher, Sr. Director, Health Care Affairs
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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