Becker's Hospital Review

15 CFO / FINANCE CMS' proposed inpatient payment rule for 2021: 7 things to know By Alia Paavola C MS released its annual Inpatient Prospective Pay- ment System proposed rule April 27, which rec- ommends removing some price transparency re- quirements. Here are seven things to know about the proposal: 1. Payment rate update. Under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs will see a net 2.8 percent increase in Medi- care rates in fiscal year 2022, compared to 2021. CMS said the payment rate adjustment will mean hospitals see an in- crease of about $3.4 billion in payments in fiscal year 2022. 2. Price transparency requirements. CMS proposed re- pealing the requirement to report median payer-specific negotiated rates by Medicare severity diagnosis related group to Medicare Advantage insurers. CMS said this will reduce administrative burden on hospitals by about 64,000 hours. 3. Disproportionate share payments. CMS is proposing to distribute about $7.6 billion in disproportionate share payments in fiscal 2022, a decrease of about $660 million from fiscal year 2021. 4. Add-on payment for COVID-19 treatment. e proposed rule would extend the add-on payment for COVID-19 treatment through the end of the fiscal year in which the public health emergency ends. 5. Value-based payment programs. CMS proposes to sup- press most hospital value-based purchasing program mea- sures during the public health emergency for COVID-19. As a result, hospitals would receive neutral payment ad- justments under the value-based program in fiscal 2022. 6. Inpatient Quality Reporting Program. CMS pro- posed several changes to the Inpatient Quality Reporting Program, which reduces payment to hospitals that fail to meet program requirements. CMS is seeking to add five new measures, including COVID-19 vaccination rates among healthcare personnel, a metric targeting mater- nal morbidity and two medication-related adverse event electronic clinical quality measures. CMS also wants to remove the exclusive breast milk feeding measure, among other changes. 7. Graduate medical education slots. CMS proposed adding 1,000 new Medicare-funded medical residen- cy positions to train physicians. About 200 slots per year would be phased in beginning in fiscal year 2023. CMS said it expects to spend $1.8 billion to add these residency slots. n 7 low-value services cost Medicare nearly $500M a year, UCLA study finds By Morgan Haefner N early $500 million is spent a year on preventive medical ser- vices for Medicare patients that are considered "low value," according to a study led by researchers from the University of California Los Angeles. The research, published April 14 in the Journal of General Internal Med- icine, looked at National Ambulatory Medical Care Survey data across seven preventive services given a "D" rating by the U.S. Preventive Ser- vices Task Force, an independent HHS panel. A "D" rating means the service likely has no health benefits and could even harm patients. The seven services studied, which include heart disease screening for low-risk adults and cancer screenings for adults over a certain age, were performed 31 million times annually during the study pe- riod, which ran from 2007 to 2016. Added up, all those services cost $478 million a year. "Medicare could save nearly $500 million per year and protect pa- tients against potential harm by no longer providing reimburse- ments for these services," the authors concluded, according to an April 28 news release. n Tennessee revises certificate-of- need law, raising fees for hospitals, exempting others By Alia Paavola T ennessee Gov. Bill Lee signed into law May 26 a bill that makes several changes to the state's certificate-of-need requirements and raises fees for providers. Certificate-of-need laws require hospitals to seek approval from the state to build new facilities or add services or beds. The goal of the laws is to limit unnecessary services and increase competition. Under the revised Tennessee law, hospitals will have their annual fees increased from paying up to $300 to paying up to $5,000 for the certificate-of-need program. Ambulatory surgery centers will have to pay $2,000, up from $100. Lawmakers said they expect the fees to help bring in $1.3 million in revenue per year. In addition, mental health hospitals and hospital-based outpatient treatment centers for opioid addiction are exempt and don't need a certificate to open. Additionally, existing hospitals can increase their bed count at their main facility without approval. But they still need to apply to add different types of beds or beds at satellite locations. The law also decreases the certificate-of-need application pro- cess by 75 days. n

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