CMS pitches inpatient payment rule for 2025: 8 things to know

CMS released its annual Inpatient Prospective Payment System proposed rule April 10, which proposes a reimbursement boost for acute care hospitals.

Here are eight things to know about the proposed rule: 

1. Payment rate update: Under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs would see a net 2.6% increase in payments for fiscal year 2025 compared to 2024. CMS said it anticipates the rate adjustment will increase total hospital payments by $3.2 billion. 

2. Long-term care hospitals: CMS is proposing an overall increase of 1.6% — or $41 million — in standard payments to long-term care hospitals in 2025 compared to 2024. 

3. TEAM model: CMS is proposing a mandatory model to test whether episode-based payments for five common, costly procedures would reduce Medicare expenditures while preserving or enhancing the quality of care. The "Transforming Episode Accountability" model could incentivize coordination between providers both during and 30 days after a surgery, and require referral to primary care services to support continuity of care and drive positive long-term health outcomes.

4. Essential medicines: CMS is proposing a separate payment to small, independent hospitals for establishing and maintaining access to a buffer stock of essential medicines.  

5. SDOH: CMS is proposing adding new social determinants of health data elements in long-term care hospital quality reporting that would require hospitals to report elements on housing, food and utility stability, and access to transportation, which are factors that influence the resources required for their care.

6. Emergency preparedness: CMS is proposing a permanent streamlined data reporting structure for COVID-19, influenza and RSV, with additional reporting that could be activated during an emergency. The rule proposes a new attestation-based measure to assess whether hospitals demonstrate a structure, culture, and leadership commitment that prioritizes patient safety.  

7. Maternal health: In an effort to improve access to quality care during pregnancy, childbirth and postpartum, CMS is seeking public comment on potential solutions that can be implemented through the hospital Conditions of Participation. 

8. Comment period: CMS will accept comments on the proposed rule through June 10.

Read CMS' fact sheet on the proposed rule here

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