- The program now begins April 1, 2016, giving hospitals three more months to prepare for this new payment methodology.
- The list of MSAs which will be required to participate has changed, with 8 areas dropped from the list.
- Hip Fractures will get their own pricing, associated with DRG 470, since the cost for these non-elective procedures tends to be greater than the elective ones.
- Quality links to payment changed (and became more complicated)
- Stop-loss (and stop-gain) provisions limit the financial impact of the rule as follows:
- Year 1: (really 9 months) No loss; 5% gain
- Year 2: 5% loss; 5% gain
- Year 3: 10% loss; 10% gain
- Year 4/5: 20% loss; 20% gain
There is concern in the press that making this program mandatory is a sea change from CMS. It shouldn't come as a surprise; the program has been promising to move large percentages of care away from the fee for service model over the next few years. A frequent, expensive operations such as a Lower Extremity Joint Replacement (LEJR) seems like a good place for them to begin in a big way.
If hospitals do the right thing with their surgeons and especially with their post-acute providers, this program could prove to actually achieve the Triple Aim:
- Improve the patient experience of care (including quality and satisfaction);
- Improve the health of populations
- Reduce the per capita cost of health care
