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.

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13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

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.

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