The Centers for Medicare and Medicaid Services (CMS) released the Inpatient Prospective Payment System (IPPS) Final Rule on Aug. 1 for fiscal year 2024. The rule’s provisions will go into effect starting Oct. 1. The increase in operating payment rates for general acute care hospitals paid under the IPPS was finalized at 3.1%, representing a 3.3% increase in the hospital market basket with a 0.2% reduction for the productivity adjustment.

Some notable finalized provisions that ACC commented on include:

• Atrial Valve Replacement (AVR) + Mitral Valve Replacement (MVR) + Surgical Ablation Medicare Severity-Diagnosis Related Group (MS-DRG) change: The rule finalizes placement of the concomitant performance of these three procedures into MS-DRG 212, increasing the reimbursement. ACC and other stakeholders asked that concomitant performance of a single valve replacement (either AVR or MVR) with surgical ablation also be assigned to the higher reimbursing MS-DRG, but CMS advised the cost analysis did not warrant such a move.
• Intravascular Lithotripsy (IVL) placed in newly created MS-DRG: The rule finalizes the newly created IVL MS-DRG. ACC supported this while adding that atherectomy procedures should be considered for the new MS-DRG or a newly created MS-DRG of their own. No changes beyond the IVL code were made in this final rule; however, the agency did note they would “continue to evaluate the claims data” of PCI procedures and “address any proposed modifications to the existing logic in future rulemaking.”
• New Technology Add-on Payments (NTAP) eligibility changes: The rule finalizes moving the date of the U.S. Food and Drug Administration authorization required for NTAP applications from July 1 to May 1. This leaves only a one-month window for new technologies to receive three years of NTAP rather than two years, for those submitting only between April 1 and May 1 of any given year. ACC proposed that all NTAP eligible items should be given three years of NTAP. CMS advised that three years of NTAP are not inherently necessary, but they acknowledged the very narrow window to achieve the three-year NTAP designation and will explore expanding this window in future rulemaking. 
• Health Equity Scoring Adjustment added to the Hospital Value-Based Purchasing Program: The rule finalizes adding points to the Total Performance Score for health equity performance. While supportive, the ACC suggested performing a pilot study of this addition to the system to analyze its impacts. CMS noted that they performed sufficient analysis based on prior years data with simulated impacts of the new health equity scoring and will proceed with the proposed addition.

Access ACC’s full comment letter here. For more information, view either the full final rule or the CMS fact sheet.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Atherectomy, Lithotripsy, Diagnosis-Related Groups, Medicare, Percutaneous Coronary Intervention, Mitral Valve, United States Food and Drug Administration, Medicaid, Pilot Projects, Inpatients, Centers for Medicare and Medicaid Services, U.S., United States, ACC Advocacy

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