CMS finalizes physician fee schedule for 2016

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The Centers for Medicare & Medicaid Services has released its finalized 2016 Medicare payment rules for hospitals, physicians and other providers.

The payment rules, released late Friday, include updates to the Hospital Outpatient Prospective Payment System that finalize the polarizing “two-midnight” rule without changes suggested by industry stakeholders, including the American Health Care Association. The two-midnight rule, which is currently under an enforcement delay, requires patients to be a hospital for at last two midnights before they qualify as an inpatient.

When asked for comments on the finalized rules, AHCA officials responded with a letter sent by the organization and other groups, including LeadingAge and AARP, to CMS Acting Administrator Andy Slavitt in late August. The letter urged CMS to revise its inpatient definition to count any time spent in the hospital, which would allow more Medicare beneficiaries to qualify for skilled nursing facility coverage.

“A patient's actually receiving ‘medically necessary' care in the hospital, not the classification of the care as ‘inpatient,' is the key factor for determining the patient's eligibility for subsequent Part A SNF coverage,” the letter reads.

The American Hospital Association said in a statement that they applaud the finalized two-midnight rule, but are “disappointed” over CMS' Hospital Outpatient Prospective Payment System as a whole.

“It is unfortunate that hospitals and the patients they serve are now left to deal with the consequences of CMS' faulty math,” said AHA Executive Vice President of Government Relations and Public Policy Thomas Nickels. “We continue to be troubled by CMS' actuaries' lack of transparency, which is untenable.”

The finalized rules also include a provision that will establish a payment rate for physicians and other providers to provide advance care planning services.

The new payment rate will allow providers and beneficiaries to have advance care planning conversations when they're “most appropriate” for patients and their families, rather than the current rate which only covers advance care planning at the beginning of Medicare enrollment.

The advance care planning rule, which was proposed in July, earned support from long-term care groups, including the Society for Post-Acute and Long-Term Care Medicine.

“Post-acute and long-term care practitioners provide quality and thoughtful care and family members and friends of very ill patients will receive greater peace of mind that the care their loved ones receive is based on adequate medical information, collaborative goal setting, as well as respect for personal wishes and values in order to maximize comfort and quality of life,” wrote AMDA President Naushira Pandya, M.D, in a statement following the rule's proposal.

The finalized rules will go into effect on or after January 1, 2016.