Hospitals see $4.8B lift in final CMS payment rule that focuses on price transparency, interoperability

Doctor computer
Sharing medical records with patients is heavily weighted in CMS' new payment rule. (Getty/andrei_r)

The Centers for Medicare & Medicaid Services (CMS) has finalized a hospital payment rule that includes an additional $4.8 billion for inpatient services as well as several new requirements around price transparency and data sharing.

The rule will reduce the regulatory burden on hospitals by eliminating a number of reporting measures, saving hospitals more than 2 million burden hours and $75 million each year, according to the agency.

Hospitals will see an average pay increase of approximately 3% to account for the change in prices for goods and services.


9 Tips for Implementing the Best Mobile App Strategy

The member mobile app is a powerful tool for payers and members. It can help improve health outcomes, reduce operational costs, and drive self-service — anytime, anywhere. In this new eBook, learn tips and tricks to implementing the best mobile app strategy now.

Under the final Inpatient Prospective Payment Systems (IPPS) rule (PDF), hospitals will be required to make public a list of standard charges on the internet or in a machine readable format by Jan. 1, 2019. Hospitals will need to update that list annually or as appropriate.

RELATED: CMS floats proposal tying medical records sharing to Medicare participation

CMS has also made interoperability a key focus of the updated payment rule, finalizing changes to the Meaningful Use program, now known as “Promoting Interoperability.” CMS has shifted the program to focus heavily on providing patients with medical information. The “Provider to Patient Exchange” measure, defined as providing “timely electronic access to their health information” is weighted at 40 points, more than any other measure under the program.

Hospitals that score low on that measure are less likely to avoid the downward adjustment rate.

“We will be penalizing hospitals that don’t provide patients access to their health information,” CMS Administrator Seema Verma said in a press call with reporters.

Notably, CMS will not make health records sharing part of its Medicare Conditions of Participation after it issued a request for information regarding the possible change in the proposed rule in April. CMS said stakeholder feedback would “will inform next steps in advancing this critical initiative.”

RELATED: CMS rebrands Meaningful Use, reduces reporting measures

The updated program also includes changes to the reporting measures, including two new e-prescribing measures. Requiring physicians to query a prescription drug monitoring program and verifying a patient’s opioid treatment agreement. Both would be voluntary in 2019, but the PDMP query requirement is mandatory in 2020.

The agency also sought information about surprise out-of-network bills. CMS said it would consider the information and suggestions for future rulemaking.

Suggested Articles

Florida’s plan to import cheaper prescription drugs from Canada has tasted its first bitter pill.

Improving members' health literacy could lead to billions in savings, according to a new report from UnitedHealth Group.

Health officials in some California counties have cut ties with Verily’s COVID-19 testing sites amid concerns about data collection and privacy.