Proposed IPPS 2016 rule hones in on reimbursement for quality care

Patient Safety Monitor Insider

July 8, 2015

Since the passage of the Affordable Care Act (ACA), CMS has been slowly making its transition away from a fee-for-service methodology and toward value-based bundled payments, rewarding healthcare facilities for providing good care rather than just more care.


In May 2014, CMS officials published a viewpoint in the Journal of the American Medical Association, outlining what that transition would look like. Released in April 2015, the proposed Hospital Inpatient Prospective Payment System (IPPS) rule for 2016 is a clear reflection of that plan, emphasizing a number of quality care-related payment changes. Hospitals are eagerly awaiting the announcement from CMS regarding bundled payments which are bound to have a significant impact on health system operations. CMS notes that the Bundled Payments for Care Improvement Initiative (BPCI) has been testing four models of care since 2011. ACA requires CMS to announce these payment models by January 2016, and although the agency has not provided any guidance on how it plans to move forward with bundled payments, the proposed rule indicates CMS is seeking comment on "policy and operational issues surrounding the potential future expansion of this initiative." For now, a number of other quality-based changes could further emphasize the importance of quality over the next several years.

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