The Centers for Medicare & Medicaid Services (CMS) announced on April 18th the proposed rules for the Fiscal Year (FY) 2023 Hospital Inpatient Prepaid System (IPPS). AAMC will provide comments to CMS that expire by June 17th. In contrast to the hospital payment and quality provisions detailed below, this rule includes a weighted full-time equivalent limit and two graduate medical education (GME) proposals related to one or two local training programs. increase. [refer to related story]..
The proposed rules include the following key points in dealing with hospital payments and quality:
Payment proposal:
2023 IPPS payment renewal
CMS successfully participates in the hospital’s Inpatient Quality Reporting (IQR) program and is a meaningful electronic medical record (EHR) user, with a 3.2% operating payment rate for general acute care hospitals paid under IPPS. I proposed to raise it. This reflects a projected hospital market basket update of 3.1 percent, a decrease in productivity adjustments of 0.4 percentage points, and an increase in legally required documentation and coding adjustments by 0.5 percent points. I am. The proposed increase in operating and capital IPPS payment rates will be partially offset by a reduction in outlier payments in very high cases, with hospital payments generally increasing by $ 1.6 billion in 2023.
Medicare Disproportionate Share Hospital (DSH) and unpaid care payments
The CMS has proposed to distribute approximately $ 6.5 billion in unpaid long-term care costs in 2023. This is a decrease of approximately $ 654 million from 2022. The CMS uses the latest two-year worksheet S-10 audit data for 2018 and 2019. Distribute these funds. Beginning in 2024, the CMS has proposed using a three-year moving average of audited worksheet S-10 data. The CMS expects this to be the first year that three years of audited data will be available. Beginning in 2023, the CMS will cease to use the days of low-income insureds as a substitute for unpaid medical expenses for Indian Health Services and tribal hospitals and hospitals in Puerto Rico. Instead, the CMS suggested establishing new additional payments for these hospitals.
Medicaid Fraction
CMS has revised the definition of patients “considered to be eligible for Medicaid” to change the calculation of Medicaid fractions in the DSH calculation, and patients who are insured through the demonstration itself in Section 1115, or under the 1115 demonstration. Use of Premium Assistance approved by.
New Technology Add-on Payment (NTAP)
From 2024, CMS has proposed to publish the completed NTAP application form online. The CMS will also use the National Drug Code in place of the ICD-10-PCS Section “X” Code to identify cases involving the use of NTAP-approved therapeutic agents beginning with the 2023 transition period. I made a suggestion.
Wage index
The CMS proposed to continue the low wage index policy in 2023 in a budget-neutral way by applying adjustments to standardized amounts. The CMS proposed that after 2023, if the hospital wage index drops from the previous year’s wage index, a 5% cap will be applied regardless of the situation.
COVID-19 and Seasonal Influenza Data Reporting Criteria
As part of the entry requirements, the CMS will continue to report COVID-19 and seasonal influenza to hospitals, including the Critical Access Hospital (CAH), after the COVID-19 Public Health Emergency (PHE) is over. Proposed to request. Starting from the end of the current COVID-19PHE Declaration or the effective date of the IPPS Proposed Regulations, whichever is later, and continuing until April 30, 2024, the hospital or CAH will electronically provide daily information on COVID-19 and seasonal influenza. Need to report. In the standardized format specified by the secretary. In addition, the CMS is a vendor-neutral, federal-owned system that can accept data transmissions from various non-governmental agencies, so it sets up a framework for future reporting in the event of another PHE under the National Healthcare Safety Network. I suggested that. ..
Quality proposal:
Changes to the Performance Reward Program
The proposed rule removes penalties under the Nosocomial Infection Control Program (HACRP) and a purchase program based on hospital value in 2023, with a proposal to curb program measures to address the ongoing impact of COVID. Apply a neutral payment adjustment based on. -19PHE. CMS proposes an updated risk adjustment for HACRP, explains the COVID-19 diagnosis with PSI-90 measurements, and publicly and secretly reports medical-related infection measurement results (but PSI- in 2023). 90 measurements are not reported), suppress medical-related infection control data for the calendar year (CY) 2021 from 2024. It was also proposed to include a covariate adjustment of the patient history of COVID-19 within 1 year prior to admission as an index for all readmission measures in in-hospital readmissions. Feedback on the Reduction Program (HRRP) starting in 2023, the resumption of pneumonia readmissions in 2024, and how to update the HRRP score to encourage nosocomial infections to improve the performance of socially at-risk populations. Request.
Efforts to address health inequalities
Three new equity-specific quality indicators for the IQR program have been proposed: hospital commitment to health equity, screening for social driving force for health, and screening positive rate for social driving force for health. The first measures begin with a compulsory 2023 report, the screening measures begin with a voluntary report in 2023, and require reporting of each measure in 2024. Maternal health was addressed by the adoption of a new “birth-friendly” hospital designation. [refer to Washington Highlights, April 15] Two new maternal health measurements for IQR: Caesarean delivery electronic clinical quality measurements (eCQM) and severe obstetric complications eCQM. Each begins with a voluntary report in 2023, followed by a mandatory report in 2024. Finally, the agency seeks feedback through two requests for information (RFIs). One is unique in assessing the impact of climate change on health equity, and the other is a cross-setting framework for assessing health quality disparities across Medicare quality programs.
Other changes to the IQR program
In addition to the equity-focused measures above, five new measures have been proposed and the other two existing measures have been improved. The proposal includes an increase in the total number of eCQMs that hospitals must report from the 2024 report and a requirement for 100% completeness of medical record requirements for validation of eCQM reports starting with validation of reported data in 2022. It also included changes in reporting requirements for eCQM and hybrid measures, such as (affecting payments in 2025). The CMS also proposed new data submission and reporting requirements for future patient reporting, results-based performance measurements.
Medicare Promotion Interoperability Program (“Meaningful Use”)
The CMS has proposed to change the scoring method starting from the EHR reporting period of 2023. This includes starting to require hospitals to report measurements in prescription drug monitoring program queries. Introduced the addition of new optional means. Enable Exchange under the TrustedExchange Framework and enable Common Agreement (TEFCA) under the Health Information Exchange Objective in the 2023 EHR report. Also, as a necessary step under public health and clinical data exchange goals, new antibiotic use and antibiotic resistance as an integrated option for reporting EHR reporting after 2023 and active involvement under the goal. Measures have been added. Finally, it publicly reported specific program data starting from the EHR reporting period of 2023, adopted the addition of the IQR eCQM index, and proposed reporting requirements for coordination between the two programs.
RFI on the use of medical IT to improve quality measurements and reporting
The first RFI is an extension of last year’s RFI for advances in digital quality measurement and the use of Fast Healthcare Interoperability Resources (more commonly known as FHIR) in hospital quality programs. The second RFI is unique to the promotion of TEFCA.
