Cath Lab Digest - October 2007 - (Page 37)

OCTOBER 2007 ACVP MANAGEMENT CORNER 37 CMS Issues Final FY 2008 IPPS Rule Carol Male, Northeastern US Regional Cardiac Rhythm Disease Management, Healthcare Economics Manager, Medtronic, Inc.; Teresa Stamper-Strelitz, Southeastern US Regional Cardiac Rhythm Disease Management, Healthcare Economics Manager, Medtronic, Inc. Minneapolis, Minnesota Under the new system, the existing list of 538 DRGs will be replaced with 745 MS-DRGs that take into consideration the severity of each patient’s condition and the cost of treatment. • MS-DRG 292 Heart Failure and shock with CC; or • MS-DRG 293 Heart Failure and shock without CC/MCC. Failure to document and capture accurate and specific heart failure diagnoses may result in inappropriate grouping and will impact reimbursement. Thus, it becomes extremely important for hospitals to work with physicians and coders to ensure that accurate and specific documentation and coding occurs. For the cardiovascular service line, DRGs will be expanded according to Table 1. Note that the MS-DRGs for some of these services require one of the newly defined MCCs. CMS is planning to take a reduction in payment to account for “the effects of coding or classification changes” that might occur under the new severity system. DRG payment for both FY 2009 and FY 2010 will each reflect an additional 1.8% change, thereby effecting a total reduction of 4.8% over the threeyear period. So far, we’ve discussed some of the changes with the DRG system restructuring. Now let’s look more closely at the payment impact of the new MS-DRG implementation for FY08. O n August 1, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule that updates the Hospital Inpatient Prospective Payment System (IPPS) for Fiscal Year (FY) 2008. This Final Rule will be effective October 1, 2007, and according to CMS, reimbursement for hospitals that report quality data is expected to increase by an average of 3.5%. Overall, the estimated payment to 3,500 acute care hospitals increases by approximately $3.8 billion. This all sounds like good news! However, the detail of the FY08 IPPS rule includes the most significant change in the way hospital inpatient services are reimbursed since the adoption and implementation of the current DRG system in 1983, namely the adoption of the Medicare Severity DRG system (MSDRGs). The MS-DRGs will be phased in over the next two years using a blended payment of the old and new systems. Complications or Co-morbidities (CC) is revised to include the Major Complications or Co-morbidities (MCC) that allow the acute manifestation of the disease to be coded separately. This revision will result in DRG classifications based on the resources required to provide care. For example, under the old DRG system, if a patient has a discharge diagnosis of heart failure, the DRG would fall under DRG 127. Under the new system, heart failure diagnosis codes have been regrouped to MCCs and CCs to allow assignment to the MS-DRGs. Therefore, DRG 127 will now transition to three MS-DRGs: • MS-DRG 291 Heart Failure and shock with MCC; Payment Impact of MS DRG implementation FY 08 The application of the case volume per CMS results in the following volumeadjusted payment changes. • Pacemaker and cardiac resynchronization therapy pacemaker (CRTP): 1.4% increase • Pacemaker revisions (includes insertable loop recorder, ILR, Implant): -1.2% decrease • Pacemaker or CRT-P device replacements: 3.7% increase • Implantable Cardioverter Defibrillator (ICD) and CRT-D: 0.1% increase • ICD or CRT-D lead or generator: 4.0% increase • Heart Failure & Shock: 0.9% increase • Syncope & Collapse, Insertable Loop Recorder Explants: 1.4% increase • Drug-Eluting Stent: -4.1% decrease • Bare Metal Stents & Percutaneous Transluminal Coronary Angioplasty (PTCA): -8.6% decrease • PTCA w/o Stent Procedures: 10.3% increase • Endovascular/Abdominal Aortic Aneurysm (AAA): 2.6% increase • Peripheral Vascular: 0.0% increase • Heart Valves: 1.4% increase • Coronary Artery Bypass Graft (CABG): 1.2% increase Outlier payments to hospitals for particular cases that exceed the usual Medicare payment by a set threshold will be lowered for FY 2008. The outlier threshold is being lowered to $22,650 in FY08 from $24,485 in FY07, a decrease of approximately 7.6%. The expected impact of the MSDRG system is a factor in the reduction of the outlier case threshold. In addition to the MS-DRG changes, there are several other aspects of the FY08 Final Rule that are The Medicare Severity DRG system (MS-DRGs) Under the new system, the existing list of 538 DRGs will be replaced with 745 MS-DRGs that take into consideration the severity of each patient’s condition and the cost of treatment. To accomplish this change, the current list of Table 1. Overview of Cardiac Service Line MS-DRGs MS-DRG 216, 217, 218 219, 220, 221 237 238 260, 261, 262 258, 259 226, 227 222, 223 224, 225 242, 243, 244 Brief MS-DRG Description Cardiac valve w/Cardiac Cath w MCC (216), w CC (217), w/o CC/MCC (218) Cardiac valve w/o Cardiac Cath w MCC (219), w CC (220), w/o CC/MCC (221) Major CV procedures w MCC Major CV procedures w/o MCC Pacemaker revisions w MCC (260), w CC (261), w/o CC/MCC (262) Pacemaker device replacement w MCC (258), w/o MCC (259) ICD implant w/o Cardiac Cath w (226) and w/o MCC (227) ICD implant, w/Cardiac Cath/with AMI, HF or shock (222) and w and w/o MCC (223) ICD implant, w/Cardiac Cath/without AMI, HF or shock (224) and w and w/o MCC (225) Permanent Cardiac Pacemaker w MCC (242), w CC (243), and w/o CC/MCC (244) Current DRG 104 105 110 111 117 118 515 535 536 551 and 552

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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