CMS issues final payment rules for hospitals, physicians

Clarifies two-midnight rule criteria; creates policies for shared savings, SGR replacement

The federal government has issued new guidelines under a final rule that clarifies when inpatient admissions will be covered under the "two-midnight rule."

The Centers for Medicare & Medicaid Services late last week released several final rules for payments to physicians and hospitals, featuring detailed policies on the two-midnight rule, shared savings, and advance care planning.

The rule clarifies when inpatient admissions qualify for Medicare Part A payments under the two-midnight rule, according to the CMS announcement. The agency said the guidelines emphasize the importance of a physician's medical judgment in meeting the needs of Medicare beneficiaries by calling for a more collaborative approach to education and enforcement.

CMS also modifies the Medicare Shared Savings Program, adding a quality measure for statin therapy to treat and prevent cardiovascular disease.

In the physician fee schedule final rule, CMS also modifies the Medicare Shared Savings Program, adding a quality measure for statin therapy to treat and prevent cardiovascular disease.

In addition, a third rule finalizes CMS rules on Medicare's end-stage renal disease quality incentive program, driving dialysis care quality by applying quality incentives to dialysis facilities and reducing payment rates for those facilities that do not meet CMS' minimum performance score for related quality measures, according to the announcement.

The agency will also reimburse doctors who discuss advance directives, hospice care and other end-of-life issues, six years after controversy swirling around "death panels" got a similar provision dropped from the Affordable Care Act.

CMS also will begin a new payment system for physicians and other practitioners to replace the sustainable growth rate (SGR) formula. The Merit-Based Inventive Payment System (MIPS) will be formally implemented in 2019, according to a CMS fact sheet.

"These rules continue to advance value-based purchasing and promote program integrity, making Medicare better for consumers, providers, and taxpayers," said CMS Acting Administrator Andy Slavitt. "We received a large number of comments supporting our proposal to allow physicians to bill for advanced care planning conversations and we are finalizing this rule accordingly."

To learn more:
- read the fact sheet
- here's the announcement
- read the physician payment final rule (.pdf)
- here's the hospital outpatient prospective payment system final rule (.pdf)
- read the end-stage renal disease rule (.pdf)

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