November 15, 2013
Some hospitals received a higher proportion of Medicare inpatient prospective payment system reimbursements from outlier payments than others during calendar years 2008-2011, according to a report released yesterday by the Department of Health and Human Services’ Office of Inspector General. Specifically, outlier payments to 158 hospitals averaged 12.8% of their Medicare IPPS reimbursements, compared to an average of 2.2% for all other hospitals. “In some cases, high charges could be the result of high costs because hospitals attract a disproportionate share of exceptionally costly patients or apply costly technologies and treatments,” OIG said. “Still, the routine receipt of outlier payments for certain MS-DRGs [Medical Severity Diagnostic Related Groups] at high-outlier hospitals raises concerns about why charges for similar patient-care cases vary substantially across hospitals.” The report recommends that the Centers for Medicare & Medicaid Services instruct its contractors to increase monitoring of outlier payments; include information about the distribution of outlier payments with other publicly reported hospital data; and examine whether MS-DRGs associated with high rates of outlier payments warrant coding changes or other adjustments. In the report, CMS agreed with the recommendations. Commenting on the report, AHA said, “Medicare outlier payments are necessary to protect hospitals from significant financial losses resulting from patient-care cases that are extraordinarily costly. We appreciate the OIG’s efforts on this issue and believe that CMS has and continues to address the recommendations made by the OIG.”
Source: AHA News http://www.ahanews.com/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_111513_OIG&domain=AHANEWS