The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2019 Inpatient Prospective Payment System (IPPS) final rule. The rule will be published in the federal register on August 17, 2018.
Significantly, CMS finalized its proposal to continue incorporating Worksheet S-10 data to determine uncompensated care payments for FY 2019. Additionally, CMS finalized its removal of 18 quality measures and “de-duplicating” another 25 measures. The final rule contains several changes and finalized policies, outlined below:
- Increase operating payment rates by 1.85 percent (proposed 1.75), which reflect the hospital market basket update with payment adjustments, including payment adjustments mandated by the Affordable Care Act and other legislation.
- Continue incorporating uncompensated care cost data from Worksheet S-10 of the Medicare cost report into the methodology for distributing these funds. Use Worksheet S-10 data from FY 2014 and FY 2015 cost reports in combination with insured low-income days data from FY 2013 cost reports to determine the distribution of uncompensated care payments for FY 2019. Begin auditing the accuracy and consistency of Worksheet S-10 fall of calendar year (CY) 2018. Distribute roughly $8.3 billion in uncompensated care payments in FY 2019.
- Require hospitals to publicly report a listing of its standard charges via the internet in a machine-readable format.
- Approve a new technology add-on payment for FY 2019 for Chimeric Antigen Receptor (CAR) T cell therapy and assign CAR T-cell therapy to MS-DRG 016, re-named to “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy.”
- Finalized all Medicare cost report submission proposals, except the proposal that would have required IRIS data to contain the same total counts of direct graduate medical education (GME) FTE residents (unweighted and weighted) and of indirect medical education (IME) FTE residents as the total counts of direct GME FTE and IME FTE residents reported in the hospital’s cost report.
- Allow new urban teaching hospitals that wish to form an affiliated group with other new urban teaching hospitals to do so and be eligible to receive both decreases and increases to their FTE caps.
- Finalized Quality Proposals: Finalized the removal of the 18 measures and “de-duplicate” 25 measures (removing the measure from one program, but retaining the measure in another).
- Inpatient Quality Reporting (IQR) Program: Removal of the Healthcare-Associated Infection (HAI) Measures from the IQR, but pushed back the timing of the removal one year, to CY 2020 (ending IQR reporting Dec. 31, 2019 of HAIs), to ensure consistency in collection and reporting of the data and to create a seamless transition of the quarterly public reporting on the Hospital Compare website to the Hospital-Acquired Condition Reduction Program (HACRP) and the Hospital Value-Based Purchasing (VBP) Program.
- VBP Program: De-duplication of only 4 of 10 measures from VBP (the Elective Delivery measure in the Safety Domain and the three condition-specific payment measures in the Efficiency and Cost Reduction Domain). Did not finalize proposal to remove the six patient safety (HAI) measures from VBP, and similarly did not finalize proposal to remove the Safety Domain and revise the VBP program’s domain weighting beginning in the FY 2021 program year by increasing the weight of the Clinical Care domain when calculating hospitals’ total performance scores.
- HACRP: Adopt a new scoring methodology that removes the domains and assigns equal weights to each measure for which a hospital has a measure score. Create administrative policies to collect, validate, and publicly report the National Healthcare Safety Network (NHSN) HAI quality measure data independent of the IQR Program beginning with Jan. 1, 2020 infection events and the FY 2021 applicable reporting periods.
- Promoting Interoperability Program (formerly referred to as the EHR Incentive Program): Require hospitals to use the 2015 Edition of Certified Electronic Health Record Technology (CEHRT) for reporting electronic clinical quality measures (eCQMs) in CY 2019. Adopt a new performance-based scoring methodology with a smaller set of objectives, addition of two new e-prescribing measures related to opioids, and CY 2019 requirements that hospitals to submit one, self-selected CY quarter of discharge data for four self-selected eCQMs in the IQR Program measure set, continuing the policy the agency adopted for the CY 2018 reporting period.
The AAMC will host two upcoming webinars on the IPPS final rule – one on payment policies and one on quality policies.