On April 24, the Centers for Medicare and Medicaid Services (CMS) released the Hospital Inpatient Prospective Payment System (IPPS) proposed rule for the 2019 fiscal year (FY). Based on the annual hospital payment update and policies in the proposed rule, CMS estimates that hospitals paid under the IPPS that successfully participate in the Inpatient Quality Reporting Program and meet hospital meaningful use requirements could see a 1.75 percent payment increase in FY 2019.

Key items contained within the proposed rule highlight electronic health record (EHR) interoperability, eliminating duplicate measures across IPPS quality reporting programs, reducing burdens related to documentation requirements, efforts to increase health care price transparency, annual updates to new technology add-on payments, and proposed modifications to the MS-DRG assignments for several cardiovascular procedures including pacemaker and lead insertions, heart transplants and implantation of heart assist systems and endovascular procedures using drug coated balloons. The ACC is reviewing the proposed rule in closer detail to assess the impact of these proposals.

Additional information on proposals most closely related to cardiovascular practice is outlined below:

Promoting EHR Interoperability
In addition to seeking further stakeholder input, CMS intends to improve EHR interoperability through a proposed overhaul to the Medicare and Medicaid Meaningful Use programs. Proposed actions include renaming the program as "Promoting Interoperability" and developing a new scoring methodology that emphasizes interoperability and aligns with existing initiatives for the treatment of opioid and substance use disorders. Additionally, CMS proposes changing the existing number of electronic clinical quality measures and altering the reporting period for eligible hospitals and critical access hospitals.

Streamlining Duplicated Measures Across IPPS Quality Reporting Programs
Based on the Agency’s Meaningful Measures Framework, CMS proposes to streamline 21 duplicative measures across the Hospital Inpatient Quality Reporting Program (IQR), Hospital Value-Based Purchasing Program and other IPPS quality reporting programs. CMS also proposes to remove 19 measures across these programs, including the potential removal of IQR program measures in which the associated cost outweighs the benefit of its continued use in the program.

Reducing Administrative Burdens
In response to stakeholder input, CMS plans to ease documentation requirements for Part A certification statements and inpatient admission orders, in addition to implementing policies easing the process of entering into Graduate Medical Education affiliation agreements for new urban teaching hospitals.

Considering Technology Add-On Payments
CMS is considering new technology add-on payments for various new technology applications, including embolitic protection during transcatheter aortic valve replacement. Additionally, the rule proposes discontinuation of the new-technology add-on payment for Idarucizumab, as the 3-year anniversary of its introduction to the US market occurs in the first half of FY 2019. The new technology add-on payment promotes the adoption of new treatments and procedures by providing a temporary additional payment for services and technologies that meet newness, cost and substantial clinical improvement criteria where the expected inpatient MS-DRG payment rate would be inadequate.

Improving Health Care Price Transparency
Under current law, hospitals are required to make public a list of their standard charges. CMS plans to increase the accessibility to this information by specifically requiring hospitals to publicly post their standard charges online. CMS is also seeking public comments regarding barriers to informing patients of out-of-pocket costs, necessary changes that support transparency around patient obligations for out-of-pocket costs, and the role providers should play in this initiative. Additionally, CMS is considering publicizing information on hospital non-compliance with transparency requirements, among other enforcement mechanisms in future rulemaking.

ACC plans to submit comments to CMS in response to the proposed rule. The College will continue to actively monitor any further developments to these proposals and others affecting cardiovascular care. Access a full breakdown of the proposed rule through this CMS Fact Sheet .

Keywords: ACC Advocacy, Medicaid, Value-Based Purchasing, Meaningful Use, Centers for Medicare and Medicaid Services, U.S., Health Expenditures, Transcatheter Aortic Valve Replacement, Prospective Payment System, Medicare, Electronic Health Records, Hospitals, Teaching, Education, Medical, Graduate, Heart Transplantation, Pacemaker, Artificial, Substance-Related Disorders, Endovascular Procedures

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