Although the post is for the topic “specialty hospitals,” the press release touches upon numerous important topics:
Physician-Owned Specialty Hospitals, Mark B. McClellan, MD, PhD, Administrator, CMS Senate Finance Committee | Press Release | 5.18.06
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At CMS our chief concerns are the quality of care for people with Medicare and Medicaid and the efficiency of Medicare and Medicaid spending. We make no differentiation in the application of our quality standards whether a facility is rural or urban, or for-profit or not-for-profit. Through Medicare’s conditions of participation requirements and the survey and certification process, CMS monitors and enforces quality requirements for all hospitals. If necessary, CMS has the authority to terminate a hospital’s participation in the Medicare program; and, CMS recently used this authority to put a facility in Oregon on track for such action. {not to mention Tenet}
CMS also is actively working to ensure payments for services promote quality and accurately reflect the cost of providing care. As you know, how Medicare pays for medical services can significantly impact quality and medical costs for our beneficiaries and our overall health care system. With a reimbursement system based on admissions and procedures and not outcomes or efficiency, the current system may pay for services that are ineffective, inefficient and out-of-date, instead of recognizing and encouraging quality care that prevents complications and errors. Moving toward a performance-based payment system could potentially enhance fair competition across health care settings. By leveling the financial playing field for all hospitals, Medicare payments to hospitals will more accurately reflect actual resource needs. This can be achieved, in part, for example, by reconfiguring payments to better recognize severity of illness. CMS also is considering ways to improve patient safety and the Medicare payment system by addressing “never events,” which are serious, preventable medical errors.
Public disclosure of hospital pricing and quality data also has the potential to spur quality improvements at all hospitals. Quality and cost information is increasingly available and being used by patients to create a health care system that is more transparent. We hope that this will eventually provide every patient with an opportunity to get a clear idea of the quality of providers and the price of treatment options available to them and will help them to make an informed choice about their own health care. And people may find more opportunities to save when they use such information effectively.
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Hospitals have two options when it comes to the survey. They can seek accreditation from an approved body such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or they may apply directly to CMS for a review. Reviews for CMS are carried out by individual State Survey Agencies, under contract with CMS.
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CMS Proposes to Level the Financial Playing Field for All Hospitals
In addition to the above mentioned long-range plans and goals for improving the quality of care provided at all hospitals, CMS also has taken more immediate steps designed to improve quality and tailor its payment systems to more accurately reflect the cost of care. CMS has undertaken a number of activities to improve the quality and efficiency of care delivered to Medicare beneficiaries, but also recognizes the ability of Medicare payment systems to promote quality and more accurately reflect the costs of providing services to our beneficiaries. Currently, there are several different fee-for-service payment systems under Medicare that are used to pay health professionals and other providers based on the number and complexity of services provided to patients. In general, all providers to which a specific Medicare payment system applies receive the same amount for a service, regardless of its quality or efficiency. As a result, Medicare may often pay more to hospitals that deliver care that is not of the highest quality or include unnecessary services.
CMS Developing Revisions to Ambulatory Surgical Center Payment System
In its 2005 Report to Congress, CMS found that many orthopedic and surgical specialty hospitals were more similar to ambulatory surgical centers (ASCs) than to acute care hospitals. Despite the similarity in the care provided, difference in payments for the same services encourages providers to enroll what are essentially ASCs as specialty hospitals. {D’oh!}
To address this problem, CMS is developing revisions to the list of procedures eligible for payment in ASCs to include most surgical procedures performed in hospital outpatient departments. The basic structure of the payment rates for ASCs has not been updated since 1990 and CMS is considering revising the payment methodology in ASCs to align more closely with the payment rates in other payment systems for the same procedures, which would remove much of the incentive for physicians and other investors to form orthopedic and surgical specialty hospitals in order to take advantage of the typically higher payments under the inpatient and outpatient hospital prospective payment systems.
Both the expansion to the list of procedures eligible for payment in ASCs and the payment revisions are expected to be in effect by January 1, 2008. When implemented, Medicare payments to ASCs are expected to better reflect the resources required to perform specific surgical procedures and to be similar to payments under other payment systems.
CMS Clarifies EMTALA Responsibilities in Proposed Rule
Many specialty hospitals, especially orthopedic and surgical hospitals, do not have emergency departments. As a result, there has been some confusion regarding whether these facilities are required under the Emergency Medical Treatment and Labor Act (EMTALA) to accept an appropriate transfer of an individual from a requesting hospital. The FY 2007 IPPS proposed rule clarifies that all hospitals (including specialty hospitals) with specialized capabilities must accept, within the capacity of the hospital, appropriate transfers of unstable individuals covered by EMTALA, without regard to whether the hospital has an emergency department. This clarification of current policy may result in an increase in the number of specialty hospitals accepting transfers of individuals with emergency conditions on nights and weekends. This clarification was recommended by the Secretary’s EMTALA Technical Advisory Group. The community hospital associations have supported this position. Public comments on the proposed rule are due by June 12, 2006.
Hmmmmmmmmmmmm, looks like the reasons to have a specialty hospital are dwindling…incentivized behavior trumped by governmental imperatives…a big big big “go figure.”
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