Proposed Changes to 2019 Medicare IPPS Helen Jung
What’s Changing on 10/1/2018? ü Total inpatient operating payment rate increase by 1.75% (= $4B) ü Uncompensated Care (UCC) payments increase by $1.5B ($8.25B total) ü Total IPPS increase by 3.4% ü Eliminate 19 quality measures and de-duplicate 21 quality measures starting 2021 ü Require hospitals to publish prices online
3 Important Focus Areas 1. Increase Price Transparency 2. Improve EHR Interoperability 3. Reduce Administrative Burden (“Patients over Paperwork”)
2019 IPPS : Price Transparency Require hospitals to -Surprise out-of- publish current network medical standard charges billing (esp. online by January 1, radiologists and 2019 in a machine- anesthesiologists) and readable format unexpected facility fees and physician » CA hospitals already fees after ER visits required to do this (“Payers’ Bill of - CA AB 72 already Rights) addresses this
2019 IPPS : Interoperability • Rebrand “Meaningful Use” program as “Promoting Interoperability (PI)” program • Rename MIPS’ ”Advancing Care Information” to “PI” Performance Category • Use 2015 edition certified EHR products • Stronger emphasis on measures that require exchange of health information between providers and patients
2019 IPPS : Reduce Administrative Burden (Patients over Paperwork) Ease documentation Remove duplicative, Reduce claim denials by requirements by excessively eliminating provider 2 million hours burdensome, topped written inpatient (= $75 million) out quality measures admission order
Reporting Requirements ü Across CMS’ 5 quality and value based purchasing programs, eliminate 19 measures and de-duplicates 21 measures ü Outcome rather than process measures ü Add 1 measure for claims-based, 30-day unplanned readmission ü Reduce reporting period to 90 days
FY 2019 IPPS Rate Change PROPOSED ADJUSTMENTS RATE Projected hospital market basket update 2.8% Pre-determined adjustment - 0.75% (ACA mandated) Multi-productivity adjustment - 0.8% (ACA mandated) Net market basket update 1.25% Documentation and coding adjustment + 0.5% (MACRA mandated) Estimated FY 2019 payment rate update 1.75% (= $4 billion) Total IPPS increase is 3.4% if updates to uncompensated care, capital and low- volume hospital payments are included
Changes to Uncompensated Care Payments ü Increase UCC payments by $1.5B compared to FY2018 ü Total available UCC funding = $8.25B ü Due to increase in uninsured and estimated growth in DSH payments
Important Dates to Remember: ü April 24, 2018: proposed changes released ü June 25, 2018: Public comments due ü October 1, 2018 : Finalized FY 2019 IPPS changes go into effect ü January 1, 2019 : Publish standard charges online ü July 1, 2019: New urban teaching hospitals can loan GME slots to other new urban teaching hospitals ü 2021 : changes in quality measure reporting go into effect
THANK YOU! Any other questions? helenjung@llu.edu or ihpl@llu.edu Let us know what topics you would like for us to cover next!
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