Medicare updates payment increases to acute- and long-term care hospitals

Acute care providers get a payment increase from Medicare of 3 percent and long-term care hospitals receive an update of 1.35 percent in a final rule issued Thursday by the Centers for Medicare and Medicaid Services.

In addition, CMS said it is finalizing the proposal to eliminate the 25 percent threshold policy in a budget neutral manner. Under the policy, if more than a quarter of long-term care patients come from the same acute-care hospital, the long-term care hospital gets a reduction in Medicare reimbursement.

Overall, CMS said it projects that the long-term care hospital payments will increase by approximately 0.9 percent, or $39 million in 2019. 

The 3 percent increase reflects rate updates required by law and payments for new technologies and uncompensated care, CMS said.

Technology includes the use of application programming interfaces to improve the flow of information between providers and patients. APIs enable patients to collect their health information from multiple providers and incorporate it into a single portal, application, program or other software.

Through a request for information issued in April, CMS received stakeholder feedback on solutions for achieving its goals of interoperability and the sharing of healthcare data between providers.

While the agency 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 and how to create patient-friendly interfaces to access healthcare data and compare providers.

Strengthening interoperability implements the Trump Administration's MyHealthEData. The final rule also reiterates the requirement for providers to use the 2015 edition of certified electronic health record technology in 2019 to demonstrate meaningful use to qualify for incentive payments and to avoid reductions to Medicare payments.

The final rule removes unnecessary, redundant and process-driven measures from several pay-for-reporting and pay-for-performance quality programs, CMS said.

It 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.

In all, these changes will remove a total of 18 measures from the programs and de-duplicate another 25 measures.

In addition, the final rule eliminates three measures in the long-term care hospital quality reporting program.

CMS said its changes in hospital quality and value measures will eliminate more than 2 million hours of work, saving providers about $75 million annually. This promotes the agency's patients over paperwork initiative. 

The inpatient prospective payment system/long-term care hospital prospective payment system final rule also updates geographic payment adjustments for hospitals. CMS said it is continuing to work on geographic payment disparities, particularly for rural hospitals.

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, it said.

CMS also issued final rules this week on 2019 Medicare payments and policies for the skilled nursing facility, inpatient psychiatric facility, inpatient rehabilitation facility and the hospice wage index and payment rate update.

Under the new skilled nursing facility payment model, patients can 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.

The final inpatient rehabilitation facility rule adopts advances in telecommunications technology and removes obstacles from  conducting meetings other than face-to-face. The rule also removes overly prescriptive documentation requirements for admission orders for these rehabilitation facilities.

"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," said CMS Administrator Seema Verma. "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."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com