Tag: RRP

Webinar Reviews Medicare FFS Quality-based Programs

Member News

The MHA and Data Gen hosted June 14 the second webinar focused on the Medicare fee-for-service (FFS) quality-based programs to review the Medicare readmissions reduction program (RRP) and hospital-acquired conditions (HAC) reduction programs. The Medicare FFS RRP was implemented in fiscal year (FY) 2013 and penalizes hospitals for exceeding expected readmission rates on the following six select medical conditions/procedures:

  • Acute Myocardial Infarction.
  • Heart Failure.
  • Pneumonia.
  • Chronic Obstructive Pulmonary Disease.
  • Total Hip Arthroplasty/Total Knee Arthroplasty.
  • Coronary Artery Bypass Graft.

The program excludes certain planned readmissions, with payment penalties applied to Medicare FFS inpatient payment for all discharges, ranging from 0 to 3%.

The HAC program, implemented in FY 2014, evaluates hospital performance on AHRQ claims based measures and Centers for Disease Control and Prevention chart abstracted measures, penalizing 25% of hospitals nationally. There is no upside opportunity for these two programs, with remaining whole the most favorable outcome. All program penalties benefit the CMS.

A recording and materials from the webinar are available.

Members with questions regarding these programs or webinars should contact Vickie Kunz at the MHA.

Upcoming Webinars on Medicare FFS Quality-based Programs

Member News

The MHA is partnering with DataGen to host two free webinars focused on Medicare fee-for-service (FFS) quality-based programs, which can reduce hospital inpatient FFS payments by up to 6%, depending upon hospital performance. The webinars are scheduled for June 7 and June 14 at 1:30 p.m. ET.

The first webinar will review the Medicare value-based purchasing program. Due to the pandemic, the Centers for Medicare and Medicaid Services (CMS) neither penalized nor rewarded hospitals for fiscal years (FYs) 2022 and 2023, but will do so for FY 2024. The CMS withholds 2% from Medicare FFS inpatient claims, totaling approximately $1.7 billion nationally, with these funds redistributed based on performance. The latest estimates indicate 27 Michigan hospitals will be subject to a $2.8 million payment penalty for FY 2024, with 54 hospitals gaining $6.7 million. Members are encouraged to register for the value-based purchasing webinar.

The second webinar will review the Medicare readmissions reduction (RRP) and hospital acquired conditions (HAC) reduction programs. The CMS opted not to penalize hospitals under the HAC program for FY 2023, but penalties resume in FY 2024, with 25% of hospitals nationally subject to a 1% payment penalty. The RRP evaluates readmissions for six medical conditions, with hospitals subject to penalties of up to 3% that is applied to Medicare inpatient payments for all FFS discharges. The latest FY 2024 estimates indicate 66 Michigan hospitals will be subject to a $12 million RRP penalty, with 24 hospitals subject to a $9.5 million HAC penalty. Members are encouraged to register for the RRP and HAC webinar.

Hospital quality department and finance staff are encouraged to participate in these webinars, which will be recorded and available for future reference. Members with questions should contact Vickie Kunz at the MHA.