Maryland's hospital rate-setting board approved yesterday a rule change its chairman said was designed to prevent "double-dipping" by hospitals that have subacute care units.
At issue is how the rate-setting commission should deal with hospitals offering subacute services -- less intensive than normal hospital care but more intensive than normal nursing home services. Subacute care for rehabilitating patients has been growing rapidly because it costs less -- about $450 per day, compared with $825 for acute hospital care, according to commission staff.
Charles O. Fisher, chairman of the Health Services Cost Review Commission, told objecting hospitals that if the new rules present problems, they can be changed later.
Commission staff estimates that the new rules would result in savings to the system of about $150,000 at the average hospital that offers subacute beds.
Without the changes, the staff projects, the subacute beds would result in an increase in cost to the system of about $450,000 at the average hospital -- and a windfall to the hospital, which would both be reimbursed for most subacute care by Medicare and receive a rate "bonus" from the Maryland commission for cutting the cost of regular acute care.
The hospitals, which generally maintain friendly relations with the regulators, challenged the new rules.
Larry Lawrence, a vice president of the Maryland Hospital Association, told the commission that the other rule changes earlier this year were sufficient to make sure hospitals would not overcharge.
In Maryland and across the country, nursing homes have been moving aggressively into subacute care for several years, but most hospitals have started to do so only in the past year.
But in that short time, 20 of Maryland's 50 hospitals have received permission to open subacute units, according to the hospital association. Some of those units have opened, but most are still in the planning stages.
The change approved yesterday would affect the rate "bonuses" hospitals receive for posting below-average costs for a given diagnosis.
A hospital that can do a hip replacement, for example, at a charge below the state average is allowed to build most of the savings into its rates the next year.
Overall, the "bonuses" accounted for about a third of the 7.89 percent rate increase approved, on average, for Maryland hospitals last year.
All but four hospitals earned bonuses.
Under the new rules, payments a hospital receives for subacute care would be subtracted from the dollar amount used to calculate the bonus.
Mr. Lawrence said he believes that the new rules would mean that "some hospitals decide it doesn't make sense for them to go ahead" with planned subacute units. The result, he said, is that some patients would be served in more-expensive acute beds, for a net cost to the system.
Robert Murray, executive director of the rate-setting commission, agreed that it is good to encourage the development of subacute units in hospitals. However, he said, he believes that even with the rule changes, hospitals would find the effort worthwhile.
Mr. Lawrence told the commission that hospitals had worked with commission staff for the past six months on a number of changes to the rate-setting rules, and "we're somewhat apart on one of the more minor issues."
Pub Date: 5/02/96