FY 2019 IPPS final rule: CMS reduces quality reporting requirements, updates payment rates

On Thursday, August 2, CMS released the fiscal year (FY) 2019 IPPS final rule with an overhaul of the newly coined Promoting Interoperability Programs, significant reductions to reporting requirements for quality initiatives, and updates to payment rates.

CMS made changes to the Promoting Interoperability Programs (formerly known as the Electronic Health Record Incentive Programs) to increase interoperability and flexibility while reducing burden and placing a strong emphasis on measures that require the exchange of health information between providers and patients, the final rule said.

One of the key provisions of this overhaul include finalizing a new performance-based scoring methodology consisting of a smaller set of objectives. This, CMS says, will provide a more flexible, less-burdensome structure, allowing eligible hospitals to place their focus back on patients.

According to the IPPS final rule, hospitals are now required to establish and make public a list of their standard charges. Effective January 1, 2019, CMS updated its guidelines to require hospitals to make a public, online list of their standard charges and to update this information annually, or more often, as appropriate. This, CMS says, is to encourage price transparency by improving public accessibility of charge information.

In most major rules last year, CMS requested comments from providers on methods for reducing administrative burden. In line with that request, CMS is removing quality measures from a number of quality reporting and pay-for-performance programs.

According to CMS, 18 previously adopted measures that are topped out, do not result in better patient outcomes, or have associated costs that outweigh the benefit of its continued use in the program will be removed. CMS is also deduplicating 21 measures to simplify and streamline measures across programs. These measures will remain in one of the other four hospital-quality programs.

The six healthcare-associated infection patient-safety measures that are being deduplicated will be removed for calendar year 2020, which is one year later than originally proposed in April.

In addition to provisions that reduce the number of measures that acute care hospitals are required to report across the four quality and value-based purchasing programs, CMS is aiming to reduce the number of denied claims for clerical errors in documenting physician admission orders by removing the requirement that a written inpatient admission order be present in the medical record as a specific condition of Medicare Part A payment, the final rule says.

Also, CMS says, the increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users is approximately 1.85%, whereas 1.75% was originally proposed.

According to the final rule, this reflects the projected hospital market basket update of 2.9% reduced by a 0.8%productivity adjustment. This also reflects a positive 0.5% adjustment required by legislation, and the negative 0.75%adjustment to the update required by the Affordable Care Act.

For more information on the final rule, see CMS’ fact sheet.