ALERT: Medicare Cuts for Cardiovascular

FY09 Final Inpatient Rules Published
Cardiovascular Payment Reduced Even Further

CMS Final Inpatient Rules for FY08 introduced the Medicare Severity DRGs (MSDRGs), yet another version of DRGs to redistribute payment to facilities whose patients are "sicker". 2009 cost based weights hit MDC5 yet again. Highlights of the MSDRG changes include:

• Expansion of the MSDRGs from 538 to 745. Cardiac MSDRGs (MDC5) expanded from 54 to 88. 2009 separates AICD "generator only" placements from AICD "lead only " placements.
• A radical revision of the CC list omitting the #3 diagnosis (by volume) and the #1 CC in the Medicare population 428.0 Congestive Heart Failure from the list entirely. Co-morbid conditions are divided into Major CCs and CCs.
• Redistribution of cardiac cases into lower weighted DRGs.45% of the cardiac patients who grouped to the MCV or CC DRGs in 2007 fell into the lowest severity of illness DRGs in 2008. The redistribution reduced payment for those cases by $1.2 billion.
• Payment penalties for complications that occur while a patient is in the hospital will be effective October 1, 2008.  Certain conditions not present on admission "POA" will be excluded as CCs or MCCs.

The biggest "losers" in the 2009 CMS projected impact file continue to be the large cardiovascular facilities. This is the 4th year in a row CV facilities have suffered significant reductions in Medicare payment. (Read More)