Recently, the Centers for Medicare & Medicaid Services (CMS) released its fiscal year (FY) 2019 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule. CMS proposed to reduce regulatory burdens for inpatient hospitals and increase price transparency and better data sharing between hospitals and other providers and suppliers.
Highlights from the proposed rule
The proposed rule would update Medicare payment rates for both acute care hospitals and long-term care hospitals. IPPS payment rates would increase 1.25 percent for hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users. CMS also proposes a positive 0.5 percentage adjustment required by the Medicare Access and CHIP Reauthorization Act of 2015 for a total increase of 1.75 percent for hospitals that successfully participate in the IQR Program and are meaningful EHR users. Overall, LTCH PPS payments would decrease by about 0.1 percent or $5 million in FY 2019, as CMS continues the gradual implementation of the dual payment rate system for LTCHs.
CMS further proposes substantive changes to the Medicare and Medicaid EHR Incentive Programs. In addition to renaming the programs, which would now be called the Promoting Interoperability (PI) Programs, EHR measurement would increasingly focus on interoperability (the ability of different systems to communicate, exchange data, and use the information being exchanged) and improving patient access to health information.
EHR reporting periods in 2019 and 2020 for new and returning participants attesting to CMS or a state Medicaid agency would be any continuous 90-day period within each calendar year (CY). Beginning in CY 2019, all participants would be required to use the 2015 Edition of certified EHR technology (CEHRT).
Continuing, in order to improve price transparency CMS requests comments on several topics, including: how to define “standard charges;” ways to better inform patients about out-of-pocket costs; whether health care providers should provide information on what Medicare reimburses for particular services; and whether noncompliance with transparency requirements should be public and possible enforcement mechanisms for noncompliance.
Among other changes, as part of the Meaningful Measures Initiative CMS proposes to reduce the number of measures hospitals are required to report in the quality and value-based purchasing programs by removing duplicative, highly performed, and excessively burdensome measures. CMS proposes a new measure removal factor examining whether “the costs associated with a measure outweighs the benefit of its continued use in the program.” This factor would apply to measures in the Hospital IQR, PPS-Exempt Cancer Hospital Quality Reporting Program, and the LTCH Quality Reporting Program. Based on these criteria, CMS would remove a total of 19 measures and eliminate the duplication of 21 measures across the quality and value-based programs. A detailed breakdown of the measures CMS proposes to remove is available in the CMS Fact Sheet.