Result: Cumulative Impact ofMultiple Changes in Payment (2)

• the payment changes that affect rural hospitals:
  • Payment for post acute transfers
  • DRG payment rate of growth
  • Elimination of formula-driven overpayment for certain hospital outpatient services
  • Reduced capital payments
  • Reduced disproportionate share payments
  • TEFRA cap (applies to non-PPS hospitals)
  • TEFRA relief payments
  • TEFRA bonus payments
  • Bad debt
  • Indirect Medical Education payments
  • Home health cost limits
  • Home health per beneficiary limits
  • Elimination of outlier add-on

• Effects of the payment changes exaggerated in small, low volume institutions

Rural Policy Research Center 11/8/99

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