CMS Posts Final FY11 Inpatient Rules, Payment Updates, and RHQDAPU Measures.

On Friday afternoon, CMS issued a press release announcing that the final FY11 inpatient prospective payment system rules have been posted to the Federal Register.

Excerpts of the press release is cut and pasted below wiht items of interest to healthcare quality professionals in red:

"In today’s action, CMS is updating acute care hospital rates by 2.35 percent. This update reflects a market basket increase of 2.6 percent for inflation, which is a slight increase over the FY 2010 inflation rate. The final rule reduces the 2.6 percent inflation update by 0.25 percent, as required by the Affordable Care Act. Further, CMS will apply a “documentation and coding” adjustment of -2.9 percent. Hospital coding practices following adoption of the Medicare severity DRGs increased aggregate payments to hospitals, but did not reflect actual increases in patients’ severity of illness. Under legislation passed in 2007, CMS is required to recoup the entire amount of FY 2008 and 2009 excess spending due to changes in hospital coding practices no later than FY 2012. CMS has determined that a -5.8 percent adjustment is necessary to recoup these overpayments. The -2.9 percent adjustment for FY 2011 is one-half of this amount. CMS estimates that payments to general acute care hospitals for operating expenses in FY 2011 will decline by 0.4 percent, or $440 million, compared with FY 2010 under the final rule, taking into account all factors that would affect spending."

"The final rule adds 12 measures to the RHQDAPU set, and retires one current measure – Mortality for selected surgical procedures (composite). However, only 10 of the new measures – including rates of occurrence for 8 of 10 categories of conditions that are subject to the hospital-acquired conditions (HACs) policy ‑ will be considered in determining a hospital’s FY 2012 update. The remaining 2 measures to be reported in 2011 would be considered in determining the hospital’s FY 2013 update."

The 1877 page document can be found here: http://www.ofr.gov/OFRUpload/OFRData/2010-19092_PI.pdf

• Changes to RHQDAPU start on page 505.
• The list of 47 measures adopted for FY11 start on page 517.
• The list of 55 measures adopted for FY12 start on page 567.
• The list of 57 measures adopted for FY13 start on page 595.
• The list of 60 measures adopted for FY14 start on page 606.
• A list of future potential measures being considered for adoption into RHQDAPU starts on page 608.