Reimbursement
CFOs want value-based contracts with commercial plans as the payer mix changes to one more heavily dependent on Medicare and Medicaid.
The rule also proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury.
Akron Children's Hospital gets half its reimbursement from Medicaid, with all health systems facing a changing payer mix.
Final rule disincentives include hospitals not being able to earn three quarters of the annual market basket increase.
The increase counteracts some of the financial uncertainty caused by the California state budget deficit, CalOptima says.
CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.
The decision comes after CMS lost two court cases, but the agency says it reserves the right to appeal.
CMS has been ordered to redetermine the star ratings, which Elevance says should be higher.