CMS NEWS
FOR IMMEDIATE RELEASE
August 2, 2018
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS Finalizes Changes to
Empower Patients and Reduce Administrative Burden
Changes in the Inpatient Prospective Payment System and Long-Term
Care Hospital Prospective Payment System final rule will advance price
transparency and electronic health records
Today, the Centers for Medicare & Medicaid Services (CMS) finalized
a rule to empower patients and advance the White House MyHealthEData
initiative and the
CMS Patients Over Paperwork initiative. This final rule and
others issued earlier this week will help improve access to hospital price
information, give patients greater access to their health information and
allow clinicians to spend more time with their patients.
Individually and collectively, these final rules put patients first,
ease provider burden, and make significant strides in modernizing Medicare.
The final rule issued today makes updates to Medicare payment policies and
rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term
Care Hospital (LTCH) Prospective Payment System (PPS) that will incentivize
value-based, quality care at these facilities. CMS also issued final rules
this week on fiscal year (FY) 2019 Medicare payments and policies for the
Skilled Nursing Facility (SNF) PPS, Inpatient Psychiatric
Facility (IPF) PPS, Inpatient Rehabilitation Facility (IRF) PPS, and
the Hospice Wage Index and Payment Rate Update.
“We’re excited to make these changes to ensure care will focus on the
patient, not on needless paperwork,” said CMS Administrator Seema Verma.
“We’ve listened to patients and their doctors who urged us to remove the
obstacles getting in the way of quality care and positive health outcomes.
Today’s final rule reflects public feedback on CMS proposals issued in
April, and the agency’s patient-driven priorities of improving the quality
and safety of care, advancing health information exchange and usability,
and removing outdated or redundant regulations on healthcare providers to
make way for innovation and greater value.”
Along with policy changes, the FY 2019 IPPS/LTCH PPS final rule provides
acute care hospitals an average payment increase of approximately 3
percent, which reflects rate updates required by law and payments for new
technologies and uncompensated care.
The IPPS/LTCH PPS final rule also updates geographic payment adjustments
for IPPS hospitals. CMS looks forward to continuing to work on
geographic payment disparities, particularly for rural hospitals, to the
extent permitted under current law and appreciates responses to our request
for public input on this issue. By allowing the imputed wage index
floor to expire for all-urban states, CMS has begun the process of making
geographic payments more equitable for rural hospitals.
In addition, CMS is updating the LTCH PPS standard federal payment rate
by 1.35 percent. Overall, under the changes included in the final rule, CMS
projects that LTCH PPS payments will increase by approximately 0.9 percent,
or $39 million in FY 2019. In addition, CMS is finalizing the proposal to
eliminate the 25 percent threshold policy in a budget neutral manner.
MyHealthEData and Interoperability: The policies in the
FY 2019 IPPS/LTCH PPS final rule will bring us closer to the agency’s goal
of creating a patient-centered healthcare system by increasing price
transparency and fluid information exchange — essential
components of value-based care — while
also significantly lifting the administrative burden on hospitals so they
can operate with greater flexibility and patients have the information they
need to make decisions about their own care. CMS received stakeholder
feedback on solutions for achieving interoperability, or the sharing of
healthcare data between providers, through responses to a Request for
Information (RFI) issued in April in the IPPS/LTCH PPS proposed rule.
While CMS previously required hospitals to make publicly available a
list of their standard charges or their policies for allowing the public to
view this list upon request, CMS has updated its guidelines to specifically
require hospitals to post this information on the Internet in a machine-readable format. The agency is
considering future actions based on the public feedback it received on ways
hospitals can display price information that would be most useful to
stakeholders and how to create patient-friendly interfaces that allow
consumers to more easily access relevant healthcare data and compare
providers.
The policies released today begin implementing core pieces of the White
House-led MyHealthEData
initiative through several steps to strengthen interoperability. In the
IPPS/LTCH PPS final rule, CMS overhauls the Medicare and Medicaid Promoting
Interoperability Programs (formerly known as the “Meaningful Use” program
or Medicare and Medicaid Electronic Health Record Incentive Programs) to:
- Make the program
more flexible and less burdensome
- Emphasize measures
that require the exchange of health information between providers and
patients
- Incentivize
providers to make it easier for patients to obtain their medical
records electronically
In addition, the final rule reiterates the requirement for providers to
use the 2015 Edition of certified electronic health record technology in
2019 as part of demonstrating meaningful use to qualify for incentive
payments and avoid reductions to Medicare payments. This updated technology
includes the use of application programming interfaces (APIs), which have
the potential to improve the flow of information between providers and
patients. APIs can enable patients to collect their health information from
multiple providers and incorporate it into a single portal, application,
program or other software. This will support a patient’s ability to share
their information with another member of their care team or with a new
doctor, which can reduce duplication and encourage continuity of care.
Meaningful Measures and Transparency: CMS’s Meaningful Measures initiative is centered on patient safety, quality of care,
transparency and ensuring that the measure sets providers are asked to
report make the most sense. In the IPPS/LTCH PPS final rule, CMS is
removing unnecessary, redundant and process-driven measures from several
pay-for-reporting and pay-for-performance quality programs. The final rule
eliminates a number of measures acute care hospitals are currently required
to report across the four hospital pay-for-reporting and value-based
purchasing quality programs. It also “de-duplicates” certain measures that
are in multiple programs, keeping them in the program where they can best
incentivize improvement and maintaining transparency through public
reporting. In all, these changes will remove a total of 18 measures from
the programs and de-duplicate another 25 measures while still ensuring
meaningful measures of hospital quality and patient safety. In addition to
the changes that apply to acute care hospitals, the final rule eliminates
three measures in the LTCH Quality Reporting Program. Lastly, CMS is making
a variety of other changes to reduce the hours providers spend on
paperwork. This new flexibility will allow hospitals to spend more time
providing care to their patients, thereby improving the quality of care
their patients receive. Overall, changes in the hospital quality and value
measures across the four programs will eliminate more than 2 million burden
hours for hospitals impacted by the IPPS/LTCH PPS rule, saving them about
$75 million annually after these changes are implemented.
Similarly, the Skilled Nursing
Facilities (SNF) PPS, Inpatient Psychiatric Facility (IPF) PPS and
Inpatient Rehabilitation Facility (IRF) PPS final
rules establish policies that ensure the measures those providers must
report are patient-centered and outcome-driven rather than
process-oriented. Where applicable, these changes will allow providers to
work with a smaller set of more meaningful healthcare measures and spend
more time on patient care.
CMS is also advancing Meaningful Measures
through the Hospice Wage Index and Payment Rate Update. This final rule
will make Hospice Compare public data easier and more efficient to use.
Patients Over Paperwork: The
SNF PPS final rule incorporates the agency’s Patients Over Paperwork
initiative through avenues that reduce unnecessary burden on providers by
easing documentation requirements and offering more flexibility. As part of
the agency’s actions to modernize Medicare, the SNF PPS rule establishes an
innovative new classification system, the Patient Driven Payment Model
(PDPM), which ties skilled nursing facility payments to patients’
conditions and care needs rather than volume of services provided. The new
model will better incentivize treating the needs of the whole patient,
rather than focusing on the amount of services for that patient, which
requires substantial paperwork to track over time. The PDPM approach
advances CMS’s efforts to build a patient-driven healthcare system starting
with innovation throughout Medicare’s payment systems. Under this new SNF
payment model, patients will have more opportunity to choose a skilled
nursing facility that offers services tailored to their condition and
preferences, as the payment to these facilities will be based more on the
patient’s condition rather than the specific services each skilled nursing
facility provides.
Modernizing Medicare in additional ways to
benefit patients, today’s final IRF PPS rule adopts advances in
telecommunications technology and removes obstacles that may prevent
rehabilitation physicians from conducting certain meetings without being
physically in the room. The rule also removes overly prescriptive
documentation requirements for admission orders for these rehabilitation
facilities.
For a fact sheet on the FY 2019 IPPS/LTCH PPS final rule (CMS-1694-F), please visit:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-08-02.html
To view the FY 2019 IPPS/LTCH PPS final rule (CMS-1694-F), please visit:
https://www.federalregister.gov/public-inspection/
For a fact sheet on the FY 2019 SNF PPS final rule (CMS-1696-F), please
visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-31-3.html
To view the FY 2019 SNF PPS final rule (CMS-1696-F), please visit: https://federalregister.gov/d/2018-16570
For a fact sheet on the FY 2019 IPF PPS final rule (CMS-1690-F), please
visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-31.html
To view the FY 2019 IPF PPS final rule (CMS-1690-F), please visit: https://federalregister.gov/d/2018-16518
For a fact sheet on the FY 2019 IRF PPS final rule (CMS-1688-F), please
visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-31-2.html
To view the FY 2019 IRF PPS final rule (CMS-1688-F), please visit: https://federalregister.gov/d/2018-16517
For a fact sheet on the FY 2019 Hospice Wage Index and Payment Rate
Update final rule (CMS-1692-F), please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-08-01-2.html
To view the FY 2019 Hospice Wage Index and Payment Rate Update final rule
(CMS-1692-F), please visit: https://federalregister.gov/d/2018-16539
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