Premier : Statement on Two Midnight changes in the proposed OPPS rule
July 02, 2015 at 02:21 pm EDT
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Premier, Inc.
By Blair Childs, senior vice president, Public Affairs, Premier
Members of the Premier healthcare alliance continue to have significant issues with CMS's proposed changes to the Two Midnight policy in the proposed Outpatient Prospective Payment System (OPPS) rule.
In particular, we remain troubled by the fact that CMS has offered no plans to do away with a 0.2 percent cut to inpatient payments as part of the Two Midnight policy. As we have stated in the past, CMS provided virtually no justification for these cuts that exacerbate the inadequate reimbursement reality facing hospitals under Medicare.
However, we do appreciate CMS's proposal to allow high-acuity patients to be admitted to the inpatient setting, even if their expected stay is less than two midnights, if the attending physician believes it medically necessary. This is an important shift in the policy, giving physicians decision-making authority over the best, most appropriate setting of care based on patient needs, rather than following an arbitrary timeline imposed by CMS.
Furthermore, CMS's plan to change their approach to educating providers and enforcing the Two Midnight rule by moving first-line medical reviews over to Quality Improvement Organizations (QIOs), as opposed to using Medicare Administrative Contractors (MACs) or Recovery Auditors (RACs) sends an important signal that CMS is willing to work collaboratively to ensure providers admit to the best setting of care. We appreciate that MACs and RACs will only focus on outlier providers, rather than jumping straight to punitive measures for all.
- Blair Childs, Senior Vice President, Public Affairs, Premier, Inc.
Premier, Inc. is a healthcare improvement company uniting an alliance of approximately 4,350 United States hospitals and health systems and approximately 300,000 other providers and organizations. It operates through two segments: Supply Chain Services and Performance Services. The Supply Chain Services segment includes the Companyâs group purchasing organizations (GPO), supply chain co-management, purchased services, and direct sourcing activities. The Performance Services segment consists of three sub-brands, which include PINC AI, the Companyâs technology and services platform; Contigo Health, the Companyâs direct-to-employer business; and Remitra, the Companyâs digital invoicing and payables business. It delivers technology-enabled platform that offers critical supply chain services, clinical, financial, operational and value-based care software as a service (SaaS) as well as clinical and enterprise analytics licenses, consulting services, and third-party administrator services.