"They are really trying to get at the quality and patient experience element of the Triple Aim. And they are doing more in this rule [for that] than anything we've seen before," said Johnson.

The Triple Aim, coined by the Institute for Healthcare Improvement, is a loosely defined set of goals: Improving the patient experience of care; improving the health of populations; and reducing the per capita cost of health care. It has since been adopted by CMS.


Because the Affordable Care Act is fully phased in next year, the 1,424-page IPPS proposal includes a lot. Not only does it clarify which patient stays qualify as legitimate hospital admissions, but it adds new conditions to the Hospital Acquired Conditions list, recommends changes in the readmission measures by excluding a broader range of planned readmissions, and reduces Medicare disproportionate share hospital payments.

Johnson says that taken individually these programs are not big enough to change the economics of a hospital's balance sheet. For example, the hospital readmission penalty is only a 2 percent reduction in Medicare payments. But when you add them all up, that's when it can make a difference.

"Now a hospital by 2015 will look at 8 to 9 percent of the DRG payment being at-risk. That's big," said Johnson.

After responding to public comments beginning next month, CMS is expected to issue the final rule in August.

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