What Happens When Half Your DRG Adjustment Is a Proxy?
Two factors multiply every base operating DRG payment this fiscal year. CMS published the readmission one on October 7, down to the ten hospitals sitting on the 3 percent floor. The value-based purchasing half is still the proxy table from July, the one CMS labelled as not for payment, and the agency's own proxy for readmissions missed the final factor by an average of 25.9 basis points.
Two factors multiply the base operating DRG payment on every Medicare discharge your hospital has billed since October 1.
CMS published one of them three and a half weeks ago. The other is a placeholder from July that the agency itself says will not be used to pay anybody.
Table 15 went up on October 7, and it is finished work: 2,912 CCNs, one FY 2027 readmission adjustment factor each, carried to four decimals. 2,334 of them are below 1.0, which is 80.15% of the file. The mean penalty among the penalized is 0.442%, or $44,198 on every $10 million of base operating DRG payments. 244 hospitals are at a full percent or worse, and 10 are sitting on the statutory floor of 0.97.
That is a number you can put in a forecast.
"So what is Medicare actually going to multiply your base operating DRG payment by this year?"
The rest of this brief is for subscribers.
The impact tables, the code-level detail, and the rest of the analysis sit past this line.
$50 a month, or $500 a year.
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