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CMS announces changes to better address antibiotic resistance

The Centers for Medicare and Medicaid Services (CMS) recently released information about new efforts to reform its repayment structure to better address the growing public health crisis of antimicrobial resistance.

Why the need for change?

The agency’s current repayment system incentivizes the use of antibiotic prescriptions.

Ultimately, antibiotic resistance contributes to hundreds of thousands of additional days admitted in a hospital for treatment for Medicare recipients.

How does the current system contribute to the problem?

Under the current system, the CMS lumps payment for a single diagnosis under one group. According to a CMS administrator, this results in hospitals using cheaper antibiotics that may not work as well against drug resistant infections as their newer, more expensive counterparts. This leads to an increase in drug resistant bacteria.

What did CMS change?

The agency updated its most recent inpatient prospective payment system to encourage antibiotic development and increase payment for certain medications. The CMS also allowed for the classification of drug resistance as a more severe designation for payment purposes. This will result in increased flexibility for physicians to prescribe more expensive, effective and appropriate antibiotics “without imposing a new fiscal burden upon hospitals.”

What does this mean for hospitals?

Hospitals are wise to review their practices to ensure they align with these changes. A failure to do so could lead to improper billing practices which may result in allegations of health care fraud. It may also be wise to inform physicians and other medical practitioners that are impacted by these changes of applicable updated rules.