06/09/2024 | News release | Distributed by Public on 06/09/2024 13:29
CMS published its FY 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) final rule on August 1, 2024. Under this final rule, CMS is implementing several changes to its Hospital Inpatient Quality Reporting Program (IQR program), Value-Based Purchasing Program, and the Medicare Promoting Interoperability Program. These changes will be effective October 1, 2024.
Under the final rule, CMS is making several changes to the metrics it includes in its voluntary, pay-for-reporting program for acute care hospitals, as set forth under section 1886(b)(3)(B)(viii) of the Social Security Act. Specifically, CMS is: (1) adding seven measures; (2) amending two existing measures; (3) removing five existing measures; and (4) modifying the data reporting and submissions requirements for electronic clinical quality measures (eQCMs). As further noted below, each of these revisions is to reflect changes in CMS's data collection needs as it reviews studies on hospital performance and evaluates the efficacy of current data collection processes. Ultimately, these changes indicate the types of data that an acute care hospital must track and submit to CMS to receive higher reimbursement rates. If an acute care hospital does not meet the requirements of the IQR program, the hospital's market basket update will subsequently be reduced by 25 percent. The market basket update is used by CMS to update payments to reflect input price inflation that medical service providers experience.
For data reporting and submissions requirements, CMS is implementing a "progressive increase in the number of mandatory eCQMs a hospital would be required to report" beginning with the CY 2026 reporting period/FY 2028 payment determination. CMS will also: (1) implement eCQM validation scoring based on the accuracy of eCQM data beginning with the validation of CY 2025 eCQM data affecting the FY 2028 payment determination; and (2) make medical records submission optional for reconsideration requests beginning with CY 2023 discharges/FY 2026 payment determination.
The seven additional metrics that CMS is adding to the program are as follows.
The two measures to be amended are: (1) Global Malnutrition Composite Score (GMCS); and (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey. CMS is expanding the GMCS score from hospitalized adults 65 or older to hospitalized adults 18 or older. CMS will incorporate a modified version of the HCAHPS Survey into the measure that reflects scoring changes. As discussed further below, this patient survey is being updated with variable effective dates for the different CMS programs.
The five measures to be removed are: (1) Death Among Surgical Inpatients with Serious
Treatable Complications (CMS PSI 04) measure (to be replaced by the Failure-to-Rescue measure that is being added); (2) Hospital-level, Risk-Standardized Payment
Associated with a 30-day Episode-of-Care for Acute Myocardial Infarction (AMI) measure; (3) Hospital-level, Risk-Standardized Payment Associated with a 30-day Episode-of-Care for Heart Failure (HF) measure; (4) Hospital-level, Risk-Standardized Payment Associated with a 30-day Episode-of-Care for Pneumonia (PN) measure; and (5) Hospital-level, Risk-Standardized Payment Associated with a 30-day Episode-of-Care for Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) measure. CMS is removing these measures because it believes each of these measures is more broadly covered by other existing measures or measures to be added under the final rule.
Under the final rule, CMS is also modifying two of the measures for the Hospital VBP Program. Under this program, value-based incentive payments are made in a fiscal year to hospitals based on their performance on the program's measures. The changes largely address integration needs with the Hospital IQR Program changes and implementation concerns as additional changes are considered for the HCAHPS Survey. In this final rule, CMS is specifically: (1) updating program requirements to reflect the updated HCAHPS Survey measure that would be publicly reported under the Hospital IQR Program as discussed above; and (2) modifying scoring under the Hospital VBP Program so that the Person and Community Engagement Domain of the HCAHPS Survey only evaluates its six unchanged domains for the FY 2027 through FY 2029 program years, as opposed to the nine domains that are to be implemented as of the FY 2030 program year.
The final rule also sets forth several changes to be implemented under the Medicare Promoting Interoperability Program which align with changes discussed above and reflect current performance under the program. Specifically, CMS is taking the following actions.
Under the PI program, eligible hospitals and critical access hospitals must achieve a certain number of points to avoid a downward payment adjustment. These changes demonstrate the objectives that the PI program is now focused on and that eligible hospitals and critical access hospitals must address. Additionally, as demonstrated by the final change listed above, the PI program is incrementally requiring greater compliance with its objectives by increasing the threshold points required to avoid a downward payment adjustment. Those programs that have only been meeting the prior threshold of 60 points will need to introduce changes into their programs to ensure continued compliance with the PI program.
Under the Final Rule, CMS is also renewing and revising hospital and critical access hospital Conditions of Participation data reporting requirements for data related to respiratory infections. These data reporting requirements are effective November 1st, 2024, and will require hospitals and critical access hospitals to electronically report information about COVID-19, influenza, and respiratory syncytial virus. The Secretary of Health and Human Services will set the exact reporting schedule. The Final Rule also allows the Secretary to require additional reporting categories in the event that a PHE is declared for an acute respiratory illness. These data reporting requirements are a continuation of some COVID-19 public health emergency requirements that have now expired. CMS hopes that they will serve to ensure that hospitals and critical access hospitals maintain appropriate insight into infection control needs.
For more information about the Final Rule or further analysis regarding these issues, please contact Alissa D. Fleming, Katherine Denney, or any other member of Baker Donelson's Reimbursement Group.