Fierce Healthcare January 19, 2024
Traditional Medicare’s bar for reimbursing long-term care hospitals (LTCH) for severely ill, “high-cost outlier” patients has spiked under current payment policies.
These policies are setting up long-term care providers to incur “greater and greater losses” and put beneficiaries’ future access to care at risk, the American Hospital Association (AHA) wrote in a recent white paper.
The cutoff for an expensive LTCH case to qualify for extra reimbursement, known as the high-cost outlier policy’s “fixed-loss amount,” rose 55% from FY 2023’s $38,518 to FY 2024’s $59,873. The hospital lobby wrote that it projects the cutoff to again increase by 17% in FY 2025 to $70,117—bringing an extra $54 million in losses to a subsector with total annual Medicare payments of $2.6...
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