Issue link: https://beckershealthcare.uberflip.com/i/1020287
10 CFO / FINANCE CMS' final inpatient payment rule for 2019: 9 things to know By Ayla Ellison C MS released its annual Inpatient Prospective Payment System rule Aug. 2, which increases price transparency for patients and boosts payments to acute care hospitals. Here are nine key takeaways from the 2,593-page final IPPS rule: Payment rate update 1. Under the final rule, acute care hospitals that report quality data and are meaningful users of EHRs will receive a 1.85 percent increase in Medicare operating rates in fiscal year 2019. 2. CMS arrived at this increase based on a 2.9 percent market bas- ket update and 0.5 percentage point increase required by law, adjust- ed down 0.8 percentage points for productivity and 0.75 percentage points as required by the ACA. 3. CMS projects the rate increase, together with other changes to IPPS payment policies, will cause total Medicare spending on inpatient hos- pital services to increase by approximately $4.8 billion in fiscal 2019. Uncompensated care payments 4. Uncompensated care payments will increase by $1.5 billion, bring- ing the total available uncompensated care funding to $8.3 billion in fiscal 2019. e 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. Price transparency 5. Under the final rule, hospitals are required to publish a list of their standard charges online in a machine-readable format and to update this information at least annually. Hospitals are currently required to make this information publicly available or available upon request. 6. As part of the proposed IPPS rule released in April, CMS put out a request for information to better understand what stops providers from giving patients sufficient price information and how price trans- parency can be improved. e proposed rule highlighted concerns such as surprise out-of-network billing, particularly by radiologists and anesthesiologists, and unexpected facility fees. In the final rule, CMS said information and suggestions submitted to the agency will be considered for future rule-making. Meaningful measures 7. CMS finalized the removal of 18 measures from the Inpatient Quali- ty Reporting Program that are "topped out," that are no longer relevant or whose cost of data collection outweighs the value. CMS will "de-du- plicate" an additional 21 measures, removing them from the IQR Pro- gram but retaining them in other programs. 8. e final rule includes several changes to ease documentation re- quirements. For example, the rule eliminates the requirement that cer- tification statements detail where in the medical record the required information can be found. Promoting interoperability 9. CMS finalized changes to the promoting interoperability programs, formerly known as the EHR incentive programs. e rule provides a new scoring approach and flexibility to meet meaningful use require- ments and finalizes an EHR reporting period of a minimum of any continuous 90-day period in both 2019 and 2020. n CMS pushes ACOs to take on risk with overhaul of MSSP By Ayla Ellison C MS issued a proposed rule Aug. 9 that would make sweeping changes to the Medicare Shared Savings Program, including overhauling the way ACOs share in risks and rewards. Here are seven things to know about the proposed rule: 1. The redesigned program — which CMS has dubbed "Pathways to Suc- cess" — would expand ACO partici- pation agreements from three years to five years and offer eligible ACOs two participation options: "basic" and "enhanced." 2. The basic track would allow ACOs to participate under an upside-only agreement for one to two years before gradually phasing in higher levels of risk. MSSP ACOs are currently permit- ted to participate in the upside-only track for up to six years. 3. At the highest level of risk, the ba- sic track would qualify as an advanced alternative payment model under the Quality Payment Program. 4. Under the enhanced track, ACOs would take on risk and qualify as an advanced APM immediately. 5. The proposal would hold ACOs in two-sided models accountable for loss- es even if they exit midway through a performance year. It would also autho- rize termination of ACOs with multiple years of poor financial performance. 6. The American Hospital Association expressed concern about the proposal. "The proposed rule fails to account for the fact that building a success- ful ACO, let alone one that is able to take on financial risk, is no small task; it requires significant investments of time, effort and finances," said AHA Executive Vice President Tom Nickels in a statement. "A more gradual path- way is critical for hospitals and health systems that are interested in partici- pating in risk-bearing models — par- ticularly those that are exploring such models for the first time." 7. Comments on the proposed rule are due Oct. 16. n