Medicare Inpatient Final
Rule Lowers Outlier Threshold; Makes Other Changes
August 15, 2003 - In addition to finalizing regulations
relating to direct graduate medical education (DGME) and indirect
medical education (IME) payments (see related
article), the Aug. 1 Medicare FY 2004 inpatient prospective
payment system (PPS) final
rule contains a number of other changes that will affect
Medicare payments to teaching hospitals.
In an area closely watched by the hospital community, the
final rule announced that the outlier threshold for FY 2004
will be $31,000. This amount is lower than the current threshold
of $33,560 and significantly lower than the $50,645 level
published in the proposed rule. Medicare cases for which the
costs exceed the relevant Medicare payment plus the outlier
threshold receive additional payments. The lowered threshold
is due in large part to changes to the outlier payment policy
that were finalized in regulation on June 9 [see Washington
Highlights, June 13].
The final rule also modifies the regulations relating to
Medicare payments for qualifying nursing and allied health
hospital-based programs. In response to comments, the final
rule modifies its proposed rule position to state that only
programs which, according to "industry norms," enable
a person to be employed in a capacity that he or she could
not have been employed without having first completed a particular
education program, are eligible for Medicare payments. Under
the proposed rule provisions, CMS had stated that pharmacy
residency and clinical pastoral education programs would no
longer be eligible for payments. Under the revised criterion,
certain pharmacy and pastoral education programs will remain
eligible for Medicare payments.
In other areas, the final rule:
- Increases the inpatient standardized amounts by 3.4
percent, the full increase in the hospital market basket;
- Increases the number of diagnosis-related groups (DRGs)
subject to the post-acute transfer policy from 10 to 29;
- Provides for additional payments for two "new"
items: Xigris ®, a drug used for severe sepsis, and
InFUSE ™, a lumbar tapered device for spinal fusions;
and
- Addresses a number of issues relating to counting of
hospital beds and patient days for purposes of the IME
and disproportionate share payment methodologies.
Information:
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
Get Washington Highlights
in your Inbox!
|
