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March 27, 2018

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Changes Proposed for Acute Care and Long-Term Acute Care Hospitals in Fiscal 2010

June 9, 2009:

The proposed inpatient prospective payment system (IPPS) rule for fiscal 2010 issued by the Centers for Medicare & Medicaid Services (CMS) on May 1 includes changes to payment rates and policies for inpatient services beginning October 1, 2009. The proposed payment and policy changes affect inpatient stays in acute care and long-term care hospitals (LTCHs).

CMS pays acute care hospital inpatient stays under the IPPS and inpatient stays at long-term care hospitals under the LTCH PPS, based on the patient’s diagnosis and the severity of the patient’s condition. Hospitals receive a single payment based on the Medicare-severity DRGs (MS-DRGs) payment classification assigned at discharge.

Among the proposed changes to the IPPS for fiscal is a potential increase in the outlier threshold to $24,240 to maintain outlier payments under the IPPS equal at 5.1 percent of total payments. Otherwise, CMS would have to reduce the base payments for the MS-DRGs to offset the increase in outlier payments.

No changes related to MS-DRG relative weights were proposed. However, certain orthopaedic procedures are proposed for MS-DRG reassignment to provide more appropriate payment for more complex stays. Joint replacement patients who develop an infection that requires the removal of a prosthesis and inpatient hospitalization to treat the infection and to implant a new prosthesis would be assigned to a higher-paying MS-DRG.

The proposed rule also addresses applications for new-technology add-on payments for:

  • The Auto Laser Interstitial Thermal Therapy (AutoLITT) System, an MRI-guided interstitial laser treatment for intracranial tumors
  • CLOLAR (clofarabine), a chemotherapy drug approved for treating acute lymphoblastic leukemia (ALL) in children that is pending Food and Drug Administration approval for the new indication of treating acute myeloid leukemia in adults older than 70
  • TherOx Downstream System, which uses SuperSaturated oxygen therapy (SSO2) to perfuse heart muscle with blood that has been supersaturated with oxygen to reduce infarct size and preserve heart function
  • LipiScan, which uses intravascular near infrared spectroscopy (INIRS) during coronary angiography to detect the lipid content within coronary artery plaques
CMS will accept comments on the proposed rule until June 30, and will respond to them in a final rule to be issued by August 1, 2009.


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