The final rule issued August 2 updates Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).
According to the Centers for Medicare and Medicaid (CMS), the rule is designed to empower patients through better access to hospital price information, improve the use of electronic health records, and make it easier for providers to spend time with their patients.
The final rule also updates geographic payment adjustments for IPPS hospitals in its wage index. The agency projects that LTCH PPS payments will increase by approximately 0.9 percent, or $39 million in fiscal year (FY) 2019.
The federal agency expects the new payment policies will increase total Medicare spending on inpatient hospital services by $4.8 billion in FY 2019. CMS stated in its announcement of the rule,
The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to be active healthcare consumers.
CMS will increase uncompensated care payments by $1.5 billion, bringing the total available uncompensated care funding to $8.3 billion in FY 2019. The increase stems from estimated growth in payments that would otherwise be disproportionate share payments and a change in the percentage of Americans who have health insurance.
To increase price transparency, hospitals will also have to publish standard charges online and update the information annually. The agency is also considering additional rules to minimize surprise out-of-network billing by some providers and facilities.
In this final rule, CMS overhauls the Medicare and Medicaid Promoting Interoperability Programs (formerly known as the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs for Eligible Hospitals, Critical Access Hospitals (CAHs), and Eligible Professionals (EPs)), in order to better achieve program goals. CMS stated in its announcement,
In the IPPS/LTCH PPS final rule, CMS overhauls the Medicare and Medicaid Promoting Interoperability Programs…to make the program more flexible and less burdensome; emphasize measures that require the exchange of health information between providers and patients; and incentivize providers to make it easier for patients to obtain their medical records electronically.
Key provisions of this overhaul include the following:
- The rule finalizes an EHR reporting period of a minimum of any continuous 90-day period in each of calendar years (CYs) 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency.
- For the Medicare Promoting Interoperability Program, the rule finalizes a new performance-based scoring methodology consisting of a smaller set of objectives that will provide a more flexible, less-burdensome structure, allowing eligible hospitals and CAHs to place their focus back on patients.
- CMS finalizes two new e-Prescribing measures related to e-prescribing of opioids (Schedule II controlled substances). The Query of PDMP measure will be optional in CY 2019 and will be required beginning in CY 2020. This will allow additional time to develop, test, and refine certification criteria and standards and workflows, while taking an aggressive stance to combat the opioid epidemic. The Verify Opioid Treatment Agreement will be optional for both CYs 2019 and 2020. We believe that extending the optional reporting status will allow health care providers additional time to research and implement methods for verifying the existence of an opioid treatment agreement, expansion of the use of such agreements in practice, and development of system changes and clinical workflows.
- Finalizes changes to measures, including removing certain measures that do not emphasize interoperability and the electronic exchange of health information.
- Beginning with an EHR reporting period in CY 2019, all eligible hospitals and CAHs under the Medicare and Medicaid Promoting Interoperability Programs are required to use the 2015 Edition of CEHRT.
Read more in Becker’s Hospital CFO Report
Read the CMS Fact Sheet