The Centers for Medicare and Medicaid Services (CMS) released the Fiscal Year (FY) 2025 Inpatient Prospective Payment System (IPPS) Final Rule on Aug. 1, including a 2.9% increase in operating payment rates for general acute care hospitals, representing a 3.4% increase in the hospital market basket with a 0.5% percentage point reduction for the productivity adjustment. The rule’s provisions will go into effect on Oct. 1, 2024.

The ACC commented on the following provisions, which have now been finalized:  

• Transforming Episode Accountability Model (TEAM): The rule finalized its proposal for the five-year mandatory, episode-based, alternative payment demonstration project for selected acute care hospitals beginning in January 2026. The rule published the list of 188 Mandatory Core-Based Statistical Areas selected for participation in TEAM (See TABLE X.A.-07 in the final rule). The surgical procedures included in the model will be lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, CABG and major bowel procedure. The proposal was finalized with few changes such as modifying additional flexibility for safety net hospitals and downside risk. The agency created a track for safety net hospitals to extend upside-only financial risk for the first three performance years. Update: CMS has provided a list of acute care hospitals that will be required to participate in the TEAM program. View the list here.
• Concomitant Left Atrial Appendage Closure and Cardiac Ablation MS-DRG Creation: The rule finalized creation of a new Medicare Severity Diagnosis Related Group (MS-DRG) for concomitant performance of left atrial appendage closure and cardiac ablation. CMS agreed with the ACC and other stakeholders that the pulse-field ablation ICD-10 code which was created on April 1, 2024, should be added to the proposed list of procedures included in this MS-DRG.  
• New Technology Add-on Payments (NTAP) Eligibility Changes: The rule finalized expanding the window in which NTAP can be achieved for three years rather than two years to six months after it had been reduced to just one month in the FY 2024 final rule. Despite the ACC and others advocating for all new technologies to receive three years of NTAP, CMS maintained its opposition to this proposal.  
• Minimum Scoring Threshold Increase: CMS proposed to raise the minimum scoring threshold from 60 points to 80 points for electronic health record reporting period beginning in calendar year (CY) 2025.  The final rule raises the threshold from 60 points to 70 points for CY 2025 and then from 70 to 80 points for CY 2026.  
• Clinical Episode-Based Payment Measures Removed and Replaced With MSPB Hospital Measure: CMS has decided to remove several measures from the Hospital Inpatient Quality Reporting Program for FY 2026 payment determination, including two cardiovascular-related measures: Hospital-level, Risk-Standardized Payment Associated with a 30-Day Episode of Care for Acute Myocardial Infarction and for Heart Failure. The Medicare Spend Per Beneficiary (MSPB) Hospital measure, which evaluates hospital efficiency and resource use relative to the national median hospital, will replace the condition-specific payment measures.  
• Social Determinants of Health (SDOH) Codes Made Complicating Conditions: The rule finalizes the proposed change of various SDOH codes describing various iterations of homelessness from non-complicating conditions within the IPPS system to complicating conditions. The change will allocate additional resources to hospitals treating patients suffering from homelessness or other unsafe living conditions.   

View the ACC’s comment letter on the FY 2025 IPPS proposed rule here. For more information on the final rule, access the full rule or the CMS fact sheet. 

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: ACC Advocacy, Coronary Artery Bypass, Centers for Medicare and Medicaid Services, U.S., Cardiology, Episode of Care