CMS tackles antibiotic resistance with IPPS final rule: 4 things to know

CMS' Inpatient Prospective Payment System final rule contains several changes to help combat antibiotic resistance among Medicare patients, which CMS Administrator Seema Verma outlined in an Aug. 2 blog post published in Health Affairs.

Four things to know:

1. Medicare's payment system bundles the costs of all healthcare services performed for a single diagnosis into a diagnosis-related group, which incentivizes hospitals to use "older, cheaper antibiotics that may not be effective against drug-resistant infections," Ms. Verma wrote.

2. She also said most new cases of drug-resistant infections and deaths involve Medicare patients, since they often have compromised immune systems and greater catheter use. This leads to longer lengths of stay and billions of dollars in unnecessary healthcare costs.

3. To address this issue, CMS updated the 2020 IPPS final rule to feature an alternative New Technology Add-On Payments pathway to help encourage more antibiotic development. The alternative pathway drops the "substantial clinical improvement" criteria many drugmakers have struggled to meet and increased payment from 50 percent to 75 percent for antibiotics designated as Qualified Infectious Disease Products by the CDC.

4. CMS also updated the severity level designation for multiple ICD-10 codes involving antibiotic resistance. Hospitals can now classify these cases using a "CC" designation, which indicates the presence of a complication or comorbidity that requires hospitals to use more resources than those used for a typical patient with the same diagnosis.

"Classifying drug resistance as a CC will increase payments to hospitals treating patients with [antimicrobial resistance], thus creating the financial flexibility for physicians to prescribe the appropriate new antibiotics without imposing a new fiscal burden upon hospitals," Ms. Verma wrote.

To view the full blog post, click here.


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