Hospital Payment and Quality

Each year, the Centers for Medicare & Medicaid Services (CMS) publishes regulations that contain changes to the Medicare Inpatient Prospective Payment System (IPPS) and Outpatient Medicare Outpatient Prospective Payment System (OPPS) for hospitals. Regulatory changes affecting Medicare DGME and IME payments often are included in the annual Medicare IPPS regulation. The IPPS and OPPS regulations also address the ongoing hospital quality reporting programs, as well as the implementation and modification of performance-based payment programs legislated under the Affordable Care Act (ACA). These include the Hospital Acquired Condition (HAC) Reduction, Value-Based Purchasing (VBP), and the Hospital Readmission Reduction Programs.

CMS publishes the final IPPS regulation no later than August 1, and the changes are effective at the beginning of the next federal fiscal year (October 1). The final OPPS regulation is issued no later than November 1, and changes take effect at the beginning of the next calendar year (January 1).

FY 2018 thru 2020 Medicare Inpatient PPS

Webinars:

• AAMC Webinar Recording on the FY 2020 IPPS Proposed Rule (May 20, 2019)

• AAMC Webinar Slides on the FY 2020 IPPS Proposed Rule (PDF)  (May 20,2019)

• AAMC Webinar Recording on the FY 2019 IPPS Final Rule (Quality Programs and Promoting Interoperability) (August 29, 2018)

• AAMC Webinar Slides on the FY 2019 IPPS Final Rule (Quality Programs and Promoting Interoperability) (PDF)  (August 29, 2018)

• AAMC Webinar Recording on the FY 2019 IPPS Final Rule (August 28, 2018)

• AAMC Webinar Slides on the FY 2019 IPPS Final Rule (PDF)  (August 28, 2018)

• AAMC Webinar Slides on the FY 2019 IPPS Proposed Rule (PDF)  (May 22, 2018)

• AAMC Webinar Recording on the FY 2019 IPPS Proposed Rule (May 22, 2018)

• AAMC Webinar Slides on the FY 2019 IPPS Proposed Rule (PDF)  (May 22, 2018)

• AAMC Webinar Recording on the FY 2018 IPPS Final Rule (September 5, 2017)

• AAMC Webinar Slides on the FY 2018 IPPS Final Rule (PDF)  (September 5, 2017)

• AAMC Webinar Slides on the FY 2018 IPPS Proposed Rule (PDF)  (May 15, 2017)
   

Resources:

• Quality: AAMC Quality Measures Spreadsheet (EXCEL)  (Updated: June 10, 2021)

• Previous IPPS Rules
   

CY 2017 thru 2019 Medicare Outpatient PPS

On November 1, 2016, CMS released the calendar year (CY) 2017 OPPS Final Rule.

Webinars:

• AAMC Webinar Recording on the CY 2019 OPPS Final Rule (November 28, 2018)

• AAMC Webinar Slides on the CY 2019 OPPS Final Rule (PDF)  (November 28, 2018)

• AAMC Webinar Recording on the CY 2019 OPPS Proposed Rule (August 14,2018)

• AAMC Webinar Slides on the CY 2019 OPPS Proposed Rule (PDF)  (August 14, 2018)

• AAMC Webinar Recording on the CY 2018 OPPS Final Rule (November 30, 2017)

• AAMC Webinar Slides on the CY 2018 OPPS Final Rule (PDF)  (November 30, 2017)

• AAMC Webinar Slides on the CY 2018 OPPS Proposed Rule (PDF)  (August 2017)

• AAMC Webinar Slides on the CY 2017 OPPS Final Rule (PDF)  (December 2016)

• AAMC Webinar Slides on the CY 2017 OPPS Proposed Rule (PDF)  (August 2016)