CMS updates annual Overall Hospital Quality Star Ratings
The Centers for Medicare & Medicaid Services updated the Overall Hospital Quality Star Ratings at its Care Compare website and Provider Data Catalog. CMS assigns the ratings annually and are based on safety of care, readmission rates, patient experience, timeliness of care and mortality rates. SDAHO and the American Hospital Association advocate for an ongoing systematic assessment of the methodology used for the ratings because the current methodology does not provide an apples to apples comparison of hospitals, especially rural and critical access hospitals due to the number of measures reported.
CMS finalizes 4.2% payment update for SNFs and revises nursing home enforcement authority in FY 2025
The Centers for Medicare & Medicaid Services issued a final rule for fiscal year 2025 for the skilled nursing facility prospective payment system, which will increase aggregate Medicare spending by 4.2% or $1.4 billion compared to FY 2024. This reflects a 3% market basket update, a 1.7 percentage-point increase to counter the agency’s market basket error in FY 2023, and a 0.5 percentage point cut for productivity. CMS also revised its regulations regarding its nursing home enforcement authority to allow the agency to impose additional financial penalties on facilities where health and safety deficiencies are identified.
While CMS did not propose to adopt or remove any quality measures from the SNF Quality Reporting Program, the agency finalized its proposal to adopt and modify certain patient assessment items related to health-related social needs; SNFs will be required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2027 SNF QRP. CMS also finalized its proposal to adopt a data validation process for the SNF QRP beginning the same year.
CMS also finalized a number of operational updates to the SNF Value-based Purchasing program, including policies regarding measure removal and review and corrections. The agency also makes an update to the case mix methodology used to calculate the Total Nurse Staffing measure.
CMS finalizes 3% payment update for IRFs
The Centers for Medicare & Medicaid Services released the fiscal year 2025 final rule for inpatient rehabilitation facilities (IRF), which will update IRF payments by an estimated 3% overall (or $300 million) in FY 2025. This includes a 3.5% market basket update, which is reduced by a 0.5 percentage point cut for productivity. However, IRF payments will be further decreased by an estimated 0.2% ($20 million) due to the updated outlier threshold.
While CMS did not propose to adopt or remove any quality measures from the IRF Quality Reporting Program, the agency finalized its proposal to adopt and modify certain patient assessment items related to health-related social needs; IRFs will be required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2028 IRF QRP.
CMS final rule will update IPF payments by 2.5%
The Centers for Medicare & Medicaid Services issued the final rule for the inpatient psychiatric facility (IPF) prospective payment system for fiscal year 2025. CMS will increase IPF payments by a net 2.5%, equivalent to $65 million, in FY 2025. This increase includes a market-basket update of 3.3% minus a productivity adjustment of 0.50 percentage points; it also accounts for an update to the outlier threshold so that estimated outlier payments will remain at 2.0% of total payments, resulting in a 0.3% decrease to aggregate payments. CMS also clarifies the eligibility criteria for filing all-inclusive cost reports and makes operational changes such that, beginning Oct. 1, 2024, only government or tribally-owned IPFs can file this type of cost report. For the IPF Quality Reporting Program, CMS will adopt one new quality measure on all-cause emergency department visits following IPF discharge. The agency did not finalize its proposal to require IPFs to submit patient-level quality data on a quarterly basis, and will retain the current annual requirement.
CMS hospital IPPS final rule to increase payments by 2.9% for FY 2025
The Centers for Medicare & Medicaid Services today issued a final rule that will increase Medicare inpatient prospective payment system rates by a net 2.9% in fiscal year 2025, compared with FY 2024, for hospitals that are meaningful users of electronic health records and submit quality measure data. This 2.9% payment update reflects a hospital market basket increase of 3.4% as well as a productivity cut of 0.5%. CMS expects overall payments to increase by $2.9 billion, which includes a $200 million decrease in disproportionate share hospital payments (due to a decrease in the uninsured rate), a $300 million increase in new medical technology payments, and a $400 million decrease in rural health payments if the Medicare-dependent hospital and enhanced low-volume adjustment programs are not extended by legislation.
CMS releases FY 2025 final rule for long-term care hospitals
The Centers for Medicare & Medicaid Services today finalized policy changes to the long-term care hospital standard rate payment system that will increase payments by 2.0%, or $45 million, in fiscal year 2025 relative to FY 2024. This includes a 3.0% market basket update, a cut of 0.5 percentage points for productivity, and a cut related to outlier payments, among other policies. Specifically, due to an increase in the outlier threshold, CMS will reduce outlier payments as a percentage of total LTCH PPS standard federal payment rate payments by 0.8%. CMS also finalized a rebasing of the LTCH market basket using a 2022 base year.
