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Proposed Changes to 2019 Medicare IPPS
Helen Jung
Proposed Changes to 2019 Medicare IPPS Helen Jung Whats Changing - - PowerPoint PPT Presentation
Proposed Changes to 2019 Medicare IPPS Helen Jung Whats Changing - - PowerPoint PPT Presentation
Proposed Changes to 2019 Medicare IPPS Helen Jung Whats Changing on 10/1/2018? Total inpatient operating payment rate increase by 1.75% (= $4B) Uncompensated Care (UCC) payments increase by $1.5B ($8.25B total) Total IPPS increase
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3 Important Focus Areas
- 1. Increase Price Transparency
- 2. Improve EHR Interoperability
- 3. Reduce Administrative Burden
(“Patients over Paperwork”)
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2019 IPPS : Price Transparency
Require hospitals to publish current standard charges
- nline by January 1,
2019 in a machine- readable format » CA hospitals already required to do this (“Payers’ Bill of Rights)
- Surprise out-of-
network medical billing (esp. radiologists and anesthesiologists) and unexpected facility fees and physician fees after ER visits
- CA AB 72 already
addresses this
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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
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2019 IPPS : Reduce Administrative Burden (Patients over Paperwork)
Ease documentation requirements by 2 million hours (= $75 million) Reduce claim denials by eliminating provider written inpatient admission order Remove duplicative, excessively burdensome, topped
- ut quality measures
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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
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FY 2019 IPPS Rate Change
PROPOSED ADJUSTMENTS RATE Projected hospital market basket update 2.8% Pre-determined adjustment (ACA mandated)
- 0.75%
Multi-productivity adjustment (ACA mandated)
- 0.8%
Net market basket update 1.25% Documentation and coding adjustment (MACRA mandated) + 0.5% 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
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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
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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
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