Becker's Hospital Review

14 CFO / FINANCE CMS releases 2019 IPPS proposed rule: 10 things to know By Emily Rappleye C MS filed its annual Medicare inpa- tient payment update April 24, which would increase payments to hospitals next year and follow through on some of the administration's top healthcare promises, in- cluding more price transparency for patients, reduced administrative burden on providers and a greater emphasis on interoperability. e 2019 Medicare Inpatient Prospective Payment System proposed rule also includes updated Medicare rates for long-term care hospitals. e rule applies to about 3,300 acute care hospitals and 420 long-term care hospi- tals, and would take effect Oct. 1. e rule, published in the Federal Register, is open for comment until June 25. Here are 10 key takeaways from CMS' IPPS proposed rule. Hospital rate changes 1. Acute care hospitals participating in CMS' quality programs will receive a 1.75 percent operating payment rate increase under the rule. CMS arrived at this increase based on a 2.8 per- cent market basket update and a 0.5 percentage point increase required by law, adjusted down 0.8 percentage points for productivity and 0.75 percentage points as required by the ACA. 2. All changes included, CMS expects inpa- tient Medicare spending to increase by $4 billion in fiscal year 2019. When incorporat- ing other changes in the rule and updates to uncompensated care, capital and low-volume hospital payments, the total IPPS increase is 3.4 percent. 3. CMS wants to increase uncompensated care payments by $1.5 billion compared to fiscal 2018, bringing the total available uncompensat- ed care funding to $8.25 billion. is increase stems from estimated growth in payments that would otherwise be disproportionate share pay- ments and a change in the percentage of Amer- icans who have health insurance. Price transparency 4. e rule requires hospitals to publish a list of their standard charges online. Hospitals are currently required to make this information publicly available or available upon request. 5. As part of the rule, CMS put out a request for information to better understand what stops providers from giving patients sufficient price information and how price transparen- cy can be improved. e rule calls out specif- ic concerns such as surprise out-of-network billing, particularly by radiologists and anes- thesiologists, and unexpected facility fees and physician fees aer emergency room visits. Meaningful measures 6. e proposed rule slashes measures deemed duplicative, excessively burden- some or "topped out," meaning most provid- ers consistently perform well in a measure. Across CMS' five quality and value-based purchasing programs, the rule eliminates 19 measures and "de-duplicates" an additional 21 measures. It would add one measure for claims-based 30-day unplanned readmission under its cancer hospital quality reporting program. is would go into effect in 2021. 7. e rule will also ease documentation re- quirements, giving hospitals back an esti- mated 2 million hours previously spent filing paperwork. One of the proposed changes would reduce claim denials by eliminating the requirement that providers record a writ- ten inpatient admission order in the medical record to receive Part A payment. 8. e rule also attempts to better account for social risk factors in some of its quality programs. e rule would update the Hospi- tal Inpatient Quality Reporting Program to stratify measure rates by dual-eligible Medi- care-Medicaid patients. Under the Hospi- tal-Acquired Conditions Reduction Program, CMS would start to measure hospital perfor- mance against peers with similar proportions of dual-eligible patients. Meaningful use update 9. CMS' rule aims to overhaul meaningful use to put a new focus on interoperability and flexibility. As such, it changed the name of the EHR incentive program to "Promoting In- teroperability," and proposed to update scoring methodology and add new measures, includ- ing one to address e-prescribing of opioids. 10. e rule includes a request for informa- tion from providers on ways to enhance in- teroperability with specific proposals. ese proposals will not be addressed in the final rule, but CMS plans to consider them for fu- ture rule-making. n Georgia hospital to close: 4 things to know By Ayla Ellison G ainesville-based Northeast Georgia Health System has reached a con- ditional agreement with DL Investment Holdings to buy Chestatee Re- gional Hospital in Dahlonega, Ga. Under the agreement, NGHS would close the hospital and then possibly sell the property to the University of North Georgia, also in Dahlonega. Here are four things to know. 1. Following NGHS' acquisition of Chestatee Regional, the health system would give the University of North Georgia the opportunity to purchase the property. Georgia legislators have earmarked dollars in the state's budget for fiscal year 2019 for the University of North Georgia Board of Regents to buy the property from NGHS. 2. The University of North Georgia would not occupy the property for the next few years. UNG President Bonita Jacobs said the facility could potentially house nursing, physical therapy and counseling education programs, as well as two existing outreach clinics. 3. Under the agreement, Chestatee Regional is required to notify federal regu- lators of plans to close the hospital later in 2018. This will help ensure existing liabilities are not tied to future owners or operators. 4. A specific date for the hospital's closing has not been set. "Our immediate goal is to assess what is needed to re-establish high-quality healthcare services in Lumpkin County after the hospital closes," Louis Smith, president of acute and post-acute operations for NGHS, said. "Given what in- formation we've received about existing resources, we estimate it may take as many as 12 months to complete that assessment." n

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