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Hospital Payment Policies

The House Ways and Means Committee proposed a bill last month, aimed at improving the current hospital payment policies. The bill, named Helping Hospitals Improve Patient Care Act (H.R. 5273), would also clarify the site neutral policy and address issues with the hospital readmission penalties. The House of Representatives passed the bill earlier this month.

When the Congress passed the Bipartisan Budget Act (BBA) last year, which focused on controlling the spending for the next two years, it set up a site neutral policy for all new HOPDs. This provision aimed at controlling the purchasing of physician practices by hospitals that eventually designated the practice as a hospital outpatient department. This would then make the practice eligible for higher repayments. Most of the healthcare units also objected to the site neutral policy, as it did not provide a clarification on what would make a provider a ‘new’ HOPD.

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Healthcare Payment Models

The bill by the House Ways and Means Committee would define the term ‘new’ in a proper manner, and allow hospitals to remain eligible for the revised repayment model. Also, the new law would group hospitals based on the number of Medicare and Medicaid eligible patients they treat, and then evaluate for the re-admission penalties. Lawmakers believe that this would help in processing payments in an unbiased manner, and would benefit healthcare units that provide services to different patient groups.

Experts say that though this initiative is meant only for hospitals, it is a better approach to deal with the failures to adjust against risks, which is one of the major issues in quality measurement programs. Many healthcare units argue that they feel disadvantaged for treating “difficult to treat” patients. This bill would be a beacon of hope for such practices. However, how it all sums up, is yet to be seen.

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