Raising the wage index for lower-wage, often rural, hospitals is a bit of an advantage, but by no means a big fix, added Christina Campos, administrator of Guadalupe County Hospital in Santa Rosa, N.M.
Elehwany noted that lawmakers have talked about boosting rural payments but have taken little action. Several bills were introduced last Congress that would have reversed some prior cuts to rural hospitals. The Save Rural Hospitals Act, for instance, called for ending cuts to facilities instituted by budget sequestration and eliminating cuts to disproportionate-share hospitals mandated by the Affordable Care Act. While Congress has moved to delay the DSH cuts, other reforms were not addressed and legislation has yet to be reintroduced in the new Congress.
HHS Secretary Alex Azar also bashed the wage index during a Senate hearing earlier this year, but said that there is only so much his department can do on its own.
“I appreciate you recognize so much of the absurdity is based in statute,” Azar said to Sen. Sheldon Whitehouse (D-R.I.), who questioned Azar about the disparity during the hearing.
The proposed rule also laid out some new changes to the data that the CMS provides for calculating the wage index.
Hospitals often will refer to printed or online documents from the CMS’ public-use files to calculate their own wage index. However, the CMS will occasionally round data, which has led to inconsistencies for stakeholders making their own calculations.
“Therefore, to help ensure consistency in the calculation, we are proposing to modify how the wage data numbers are rounded,” the CMS proposed rule stated.
The agency will not round up or down certain data such as cost support. But the CMS will round numbers for any dollar amounts in the wage index calculation, such as average hourly wages, by two decimals.
The CMS identified and excluded 81 providers with aberrant data that should not be included in the wage index in 2020 unless the data is corrected.
Still, given the system’s core flaws, the ultimate impact of the wage index changes is uncertain, Ginsburg said.
“You really don’t know what these changes are going to be accomplishing, for better or worse,” he said.
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