(Jan. 3, 2008) On December 6 -7, the Medicare Payment Advisory Commission (MedPAC) met for its final 2007 meeting. During a meeting filled with sessions assessing payment adequacy in a variety of areas, the Commission began discussion of a recommendation to cut the IME adjustment by 1 percent to 4.5 percent. This recommendation had come before the group last year and is being used by Commission Chairman Glenn M. Hackbarth, JD, as a starting point for discussion. We will continue to track the Commission’s discussion on this and other important graduate medical education issues.
On November 27, the Centers for Medicare and Medicaid Services (CMS) published a final rule with comment period. The rule addresses a number of issues including Changes to the Hospital Outpatient Prospective Payment System and CY 2008 Payment Rates; the Ambulatory Surgical Center Payment System and CY 2008 Payment Rates; the Hospital Inpatient Prospective Payment System and FY 2008 Payment Rates; and Payments for
Graduate Medical Education for Affiliated Teaching Hospitals in Certain Emergency Situations Medicare and Medicaid Programs: Hospital Conditions of Participation; Necessary Provider Designations of Critical Access Hospitals.
This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from CMS’ continuing experience with this system, including describing the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to policies addressing the necessary provider designations of critical access hospitals and will institute changes to several current participation requirements. The document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110– 90. In addition, CMS is changing the provisions in the previously issued FY 2008 IPPS final rule and is establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period, CMS is modifying the regulations related to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations. The majority of provisions of this rule are in effect as of January 1, 2008. The FY 2008 IPPS payment rates, provided in section XIX of the preamble to this document, became effective October 1, 2007.
The deadlines for comments are as follows:
- Comments on the payment classifications assigned to HCPCS codes identified in Addenda B, AA, and BB to this final rule with the ‘‘NI’’ comment indicator, and other areas specified throughout this rule are due no later than 5 p.m. EST on January 28, 2008.
- Comments related to the Medicare GME teaching hospital affiliated agreement provisions are also due no later than 5 p.m. EST on January 28, 2008.
The entire document can be reviewed at: http://a257.g.akamaitech.net/7/257/2422/01jan20071800/edocket.access.gpo.gov/2007/pdf/07-5507.pdf. We will be providing a more detailed analysis of the GME-related provisions later this month.
Finally, provisions for the continuation of the Council on Graduate Medical Education (COGME) are provided in the omnibus appropriations legislation signed into law by the President on December 26, 2007. Kendall Reed, DO, Dean, Des Moines University College of Osteopathic Medicine, is a member of this important council.
See other Graduate Medical Education information.