CMS' final inpatient payment rule for 2019: 9 things to know

CMS 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 basket update and 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.

3. CMS projects the rate increase, together with other changes to IPPS payment policies, will cause total Medicare spending on inpatient hospital services to increase by approximately $4.8 billion in fiscal 2019.

Uncompensated care payments

4. Uncompensated care payments will increase by $1.5 billion, bringing the total available uncompensated care funding to $8.3 billion in fiscal 2019. The 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 transparency can be improved. The proposed ruled 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 Quality Reporting Program that are "topped out," that are no longer relevant or whose cost of data collection outweighs the value. CMS will "de-duplicate" an additional 21 measures, removing them from the IQR Program but retaining them in other programs.

8. The final rule includes several changes to ease documentation requirements. For example, the rule eliminates the requirement that certification 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. The rule provides a new scoring approach and flexibility to meet meaningful use requirements and finalizes an EHR reporting period of a minimum of any continuous 90-day period in both 2019 and 2020.

More articles on healthcare finance:

CMS' proposed outpatient payment rule for 2019: 10 things to know
CMS terminates Idaho hospital's Medicare contract
CHS sees net loss narrow to $110M, pursues $2B hospital divestiture plan


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