Medicare Compliance & Reimbursement

The Centers for Medicare & Medicaid Services hopes to soon announce a demonstration that would pay more to hospitals that provide better quality care. As reported last week in the Wall Street Journal and confirmed by CMS sources, hospitals with high quality marks would get a one or two percent bonus added to their regular reimbursements. The measures would focus on patients with eight medical conditions, including stroke, heart attack, hip surgery, and pneumonia. According to the Journal, a hospital might report how quickly pneumonia patients received antibiotics, or how many heart attack patients got beta blockers at discharge. CMS Administrator Tom Scully told the Journal that the demonstration could save money, offsetting the extra payments, by promoting better quality care that would reduce complications and hospital readmissions. However, the more skeptical Office of Management and Budget is insisting that poorly performing hospitals suffer a financial penalty in the third year of the demonstration. This could be a problem, since the demo depends on a database run by Premier, an alliance of over 200 health care systems and independent hospitals, and convincing Premier to accept OMB's position is likely to be difficult.