UPDATE: April 25, 2018: The American Hospital Association mostly praised the proposed rule, highlighting in particular the elimination of the 25% threshold policy for long-term care hospitals and CMS' decision to reduce reporting periods to 90 days.
- CMS announced Tuesday it may require that hospitals post charge information as part of the proposed 2019 Inpatient Prospective Payment System rule.
- Updated guidelines would require hospitals to post a list of their current standard charges online in a machine-readable format by Jan. 1 and to update the information annually, according to the proposed rule. “This could be in the form of the chargemaster itself or another form of the hospital’s choice,” it reads.
- CMS is also re-branding the Meaningful Use program to Promoting Interoperability and proposing to remove a total of 19 measures from quality reporting and pay-for-performance programs in addition to removing certain duplicate measures.
The rule is a hodgepodge of proposals including inpatient payment rates and policy changes that further the CMS goal of moving to more value-based care and making EHR systems more interoperable.
The agency projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $4 billion in FY 2019. That comes after a $2.4 billion bump a year earlier.
The proposal "reiterates" that providers use 2015 Edition certified EHR products in 2019 as part of demonstrating meaningful use for payment incentive programs.
Regarding quality measures for the Promoting Interoperability program, CMS proposes to cut EHR incentive program measures from six to four objectives, including health information exchange, provider-to-provider exchange, public health and clinical data exchange and e-prescribing.
"If we are going to sustain the Medicare program ... we must move to a system that pays for value and not merely volume of services," CMS Administrator Seema Verma said on a call with reporters. "These proposed rules are just the beginning of our plan to move to a value-based system."
The proposed rule would eliminate a total of 25 measures across five programs in hopes of reducing physician reporting burden. The result is an expected reduction of 2 million hours for impacted hospital providers, saving an expected $75 million.
In the rule, HHS asks for input on how the department can encourage hospitals to undertake efforts to provide consumer-friendly communication of what their potential financial liability may be for services provided at the hospitals to enable patients to compare prices between different hospitals.
Specifically, the department is asking stakeholders for input on how to define what the best measure of a “standard charge” is, how CMS can work with third parties to create patient-friendly interfaces with such data, if providers should be required to tell patients how much out-of-pocket costs for services will be prior to receiving care and if providers should be required to inform patients how much Medicare pays for specific services.
CMS is also asking for what enforcement mechanisms would be appropriate to encourage price transparency from hospitals, such as imposing civil money penalties for those that don’t comply.
Verma said she believes every provider will approach this proposal differently.
"We are just beginning this," she said on the call, adding the agency is committed helping patients have access to cost data.
As for payment changes, CMS is proposing to update the long-term care hospital prospective payment system (LTCH PPS) rate by 1.15% and increasing payment rates for general acute care hospitals paid under the inpatient prospective payment system (IPPS) by 1.75%. All proposed changes considered, the total IPPS payment increase for hospitals is projected to be 3.4%, with total LTCH PPS payments projected to decrease by approximately 0.1% in FY 2019.
The rule also proposes eliminating the 25% threshold policy for LTCHs, which CMS estimates would increase aggregate LTCH PPS payments by approximately $36 million. The American Hospital Association endorsed revoking the 25% rule.
“This will help ensure that patients get the care they need when they need it without facing arbitrary restrictions by non-patient-centered regulations,” Tom Nickels, AHA executive vice president, said in a statement.
AHA is also pleased with CMS’ decision to reduce reporting periods to 90 days. The American Medical Association proposed the same reduction for Merit-based Incentive Payment System reporting this week.