A 2.9% payment rate increase is around the corner for hospitals paid under the Inpatient Prospective Payment System (IPPS), starting with October 1, 2024 discharges. The key caveat is that hospitals must participate successfully in the Hospital Inpatient Quality Reporting (IQR) program and be meaningful electronic health record (EHR) users. Hospitals that do not successfully participate in both programs will see a payment decrease.

Here are a few key highlights that will impact many hospitals:

• Resources for Treating Patients with Inadequate Housing: Centers for Medicare & Medicaid Services (CMS) is increasing payment rates for hospitals treating patients with inadequate housing or housing instability. This change reflects higher costs for these patients and aligns with the Biden Administration's focus on social determinants of health. The change aims to improve data accuracy and support health equity.

• Quality Measures: The FY 2025 IPPS/LTCH PPS final rule introduces significant changes to the quality measure landscape for hospitals:
  • New quality measures: CMS is adding seven new quality measures to focus on patient safety, falls prevention, postoperative respiratory failure, and healthcare-associated infections.
  • Modified quality measures: Two existing measures, Global Malnutrition Composite Score and HCAHPS Survey, are being modified to improve their effectiveness.
  • Removed quality measures: Four payment measures and one PSI measure are being removed due to redundancy or the availability of more comprehensive measures.
  • Increased eCQM reporting: Hospitals will be required to report an increasing number of electronic clinical quality measures over the next several years.
  • Data validation: CMS will begin scoring eCQM data validation starting in CY 2025.
  • Care coordination focus: CMS is seeking feedback on ways to improve post-discharge care coordination and outcomes.

• Promoting Interoperability Program: CMS is making changes to this program aimed at improving data collection, enhancing patient care, and promoting interoperability among healthcare providers. These updates include:
  • Splitting the Antimicrobial Use and Resistance Surveillance measure into two separate measures.
  • Adding two new quality measures focused on patient safety.
  • Modifying the Global Malnutrition Composite Score measure.
  • Increasing the number of required electronic clinical quality measures (eCQMs) over time.
  • Raising the performance-based scoring threshold.

Be sure to check out CMS for additional information on the Hospital Readmissions Reduction Program, Hospital-Acquired Condition (HAC) Reduction Program and the Hospital Value-Based Purchasing (VBP) Program.

Stay tuned for the Medicare Physician Fee Schedule Final Rule update later this year. If you have any questions, contact your RubinBrown team!

 

Published: 09/25/2024

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