On the evening of April 24th, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes. The rule outlines payment policy for hospitals beginning October 1, 2018 (FY 2019) and contains proposals related to the Electronic Health Record (EHR) incentive program and hospital quality programs among others. Comments on the proposed rule are due by 5 PM on June 25, 2018.
Overall, CMS is estimating that the proposals in this rule will result in an estimated $4.1 billion increase in FY 2019 payments as compared to FY 2018, primarily from an increase in operating payments and uncompensated care payments. Long-term care hospitals (LTCHs) are expected to see a decrease of $5 million in payments for FY 2019 relative to FY 2018.
CMS Estimates 2.1 Percent Increase to Hospital Payments for FY 2019; DSH Hospitals to See Increase
Consistent with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and just as in FY 2018, CMS proposes a +0.5 percent MS-DRG Documentation and Coding Adjustment increase to the standardized amount of Medicare payments to acute care hospitals in 2019. CMS also proposes to update the hourly wage index used in a variety of regulatory calculations to a national average just under $43 per hour. CMS estimates that as a result of these and other policy changes, hospitals will receive an approximately 2.1 percent increase in payments as compared to 2018.
In addition, CMS is estimating that eligible Disproportionate Share Hospitals (DSH) will see an estimated $8.250 billion for uncompensated care payments. This is up from just under $6.8 billion in FY 2018.
CMS also proposes to make regulatory changes consistent with the Bipartisan Budget Act of 2018 which include discharges to hospice care by a hospice program in the post-acute care transfer policy.
New Scoring Methodology and Name Proposed for EHR Program; CMS Seeks Public Input
CMS is proposing to change the name of the Electronic Health Record (EHR) Incentive Program (also called Meaningful Use) to the Promoting Interoperability (PI) Programs. Other proposals would update the scoring methodology for eligible hospitals and adding two new opioid measures and one new health information exchange measure.
The proposed new scoring methodology includes a set of four objectives and is scored based on performance and participation. The four objectives are e-Prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange. Eligible hospitals will have to report measures in each objective and scoring will be at the individual measure level. Scores for each individual measure would be added together for up to 100 points to calculate a total Promoting Interoperability score. A score of 50 or more indicates a meaningful EHR user. CMS is also proposing to reduce the overall number of required measures to 6, down from 16.
Additionally, CMS is proposing that the EHR reporting periods for 2019 and 2019 would be a minimum of any continuous 90-day period within each of the calendar years 2019 and 2020. CMS notes that they are not proposing changes to previous policies so beginning with the CY 2019 reporting period, the 2015 Edition of CEHRT is required.
Finally, CMS included a request for information in the proposed rule. The agency would like to hear from stakeholders on advancing the electronic exchange of information between hospitals, other facilities, and patients as well as input on getting to fully interoperable health IT and EHR systems.
CMS Proposes Changes to Various Hospital Quality Programs
CMS is proposing to reduce duplication within the quality programs by making the Hospital Acquired Condition (HAC) Reduction Program the primary quality payment framework focusing on the safety of care in the inpatient hospital setting. In addition, CMS proposes to adopt a validation process into the HAC Reduction Program that largely matches the process currently used for the Hospital IQR Program and to establish the data collection period for the FY 2021 program year.
For the Hospital Value-Based Purchasing (VBP) Program, CMS proposes to remove 8 measures beginning for the CY 2019/FY 2021 payment determination. Additionally, beginning for the CY 2020/FY 2022 and CY 2021/FY 2023, CMS proposes to remove an additional 2 measures.
For the Hospital Inpatient Quality Reporting (IQR) program, CMS is proposing to remove a total of 39 measures over the next 2 years. The reasons for measure removal vary, however the overall goal is to reduce provider burden and the costs associated with reporting and maintaining the measures. CMS examined all hospital quality programs holistically and sought to remove duplicative measures across programs. Therefore, some measures removed from IQR are still represented in HRRP, VBP or HAC.
GME Affiliation Agreements For New Urban Teaching Hospitals
CMS is proposing to make changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. This would allow new urban hospitals to form affiliations and qualify for additional GME slots.
CMS Proposes Requiring Hospitals Post List of Their Standard Charges
Citing transparency and improved public accessibility, CMS is proposing that hospitals will have to make a list of their current standard charges available on the Internet. The information would have to be updated at least annually or more often when appropriate. CMS is also seeking public comment on price transparency and barriers preventing providers from informing patients about out of pocket costs.
15 Applications Received for New Technology Add-On Payments
CMS’ New Technology Add-On Program (NTAP) allows for an additional payment for medical services or technologies found to be 1) new; 2) disproportionately costly to the existing MS-DRG; and 3) a substantial clinical improvement. In 2019, CMS proposes to continue NTAP payments for 3 products while discontinuing payments for five. In addition, CMS received 15 new applications for NTAP payments.
LTCHs to See Payment Decrease
There are several proposed changes to the Long-Term Care Hospital Prospective Payment System (LTCH PPS) for FY 2019. The rule proposes the reduction of the full market basket estimate of 2.7 percent to the LTCH PPS for FY 2019. LTCHs that do not submit required quality reporting data will be subject to additional 2.0 percent reduction in LTCH PPS standard Federal payment rate.
Additionally, CMS proposes the elimination of the “25-percent threshold” policy which was under 1-year regulatory moratorium until October 1, 2018, to eliminate undue burden. In order to prevent the increase in aggregate LTCH PPS payments due to this elimination, CMS proposes the addition of a budget neutrality factor adjustment.