Updated: CMS proposes changes to empower patients and reduce administrative burden

The Centers for Medicare & Medicaid Services (CMS) proposed changes to empower patients through better access to hospital price information, improve patients’ access to their electronic health records and make it easier for providers to spend time with their patients.

To advance this, CMS included in the proposed rule issued April 24 to update the Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The IPPS and LTCH PPS proposed rules would further advance the agency’s priority of creating a patient-driven healthcare system by achieving greater price transparency and interoperability.

Additionally, CMS is re-naming the Meaningful Use program “Promoting Interoperability” effective immediately. This will also change the Merit-based Incentive Payment System (MIPS) Advancing Care Information performance category to the “Promoting Interoperability” performance category. The rebranding does not merge or combine the two programs. Websites and resources will be updated in the coming weeks to reflect the name changes.

The South Dakota Association of Healthcare Organizations (SDAHO) will be providing additional analyses of CMS rule proposals; however, highlights of the CMS proposed rule for IPPS include:

  • A market basket update of 2.8 percent;
  • A negative 0.8 percent productivity adjustment;
  • 0.5 percent adjustment required by the Medicare Access and CHIP Reauthorization Act; and
  • A negative 0.75 percent adjustment required by the Affordable Care Act.

Overall, CMS estimates the payment and policy updates as proposed — including updates to operating, uncompensated care, capital and low-volume payments — will increase payments to hospitals by approximately 3.4 percent, or $4 billion, for federal fiscal year 2019 compared to 2018. The CMS proposed rule also incorporates provisions related to the continued implementation of Medicare S-10 Worksheet data for distributing Medicare disproportionate share hospital payments, changes to the Medicare and Medicaid Electronic Health Record Incentive Program.

Proposed rules for the LTCH prospective payment system (PPS) for federal fiscal year (FFY) 2019 includes an increase by net 0.2 percent, or approximately $6 million, for traditional LTCH payments while rates for site-neutral cases would decrease by net 1.1 percent, or approximately $11 million — an overall decrease of $5 million compared to FFY 2018.

In addition, CMS proposes to eliminate the 25 percent threshold policy adjustment, which applies a financial penalty to selected admissions above a specified threshold. CMS notes that it makes this proposal because the new site-neutral payment rate has alleviated some of the concerns underlying the policy’s initial establishment. To implement this change in a budget-neutral fashion, CMS proposes a one-time, permanent adjustment of negative 0.9 percent to the standard LTCH payment rate.

CMS also proposes changes to the LTCH quality reporting program, including the removal of three measures.

Click here to read the fact sheet that discusses major provisions of the proposed rule. To read the rule in its entirety (1,883 pages), click here.

Comments are due June 25 by 5 p.m. (EST). Click here to submit a comment; follow the “Submit a comment” instructions.  Reference CMS-1694-P when commenting.