CMS Releases 2015 Medicare Inpatient Prospective Payment System Final Rule

On Aug. 4, the Centers for Medicare and Medicaid Services (CMS) released the 2015 Medicare Inpatient Prospective Payment System (IPPS) final rule, which covers payments to hospitals for services provided to inpatients. The regulation includes a number of provisions of interest to cardiovascular medicine.  Overall payments are scheduled to increase by 1.4 percent from current levels for general acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users.

Some specific items that will be implemented in 2015 include:  

  • Creation of two new Medicare Severity Diagnosis Related Groups (MS-DRGs) (266 and 267) for endovascular cardiac valve replacement with MCC and without MCC.
  • Approval of new-technology add-on payments for the MitraClip and CardioMEMs systems.
  • Implementation of the 30-day heart failure payment measure in the IQR Program. Starting in 2015, hospitals that do not successfully participate in this program will face a one quarter reduction in their applicable annual payment increase.
  • CMS will assess hospital readmission penalties using five National Quality Forum (NQF) endorsed measures for heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and hip/knee arthroplasty. In 2017, CMS will add a readmission measure (NQF #2515) for coronary artery bypass graft surgical procedures. The payment penalty for hospitals under this program will increase from 2 percent of payment in 2014 to 3 percent in 2015.

In addition to the above policies, CMS will continue to explore the development of alternative payment methodologies for short inpatient stays. Commenters suggested methods such as separate MS-DRGs for short inpatient stays, and finding a payment threshold that falls between the outpatient and full inpatient rates. CMS also stated that the Medicare Payment Advisory Commission will be discussing this issue in its upcoming cycle.

The IPPS final rule goes into effect for all discharges on or after Oct. 1, 2014. ACC staff will continue to review this rule in detail and communicate any additional items of interest through the Advocate.

Keywords: Medicare Payment Advisory Commission, Pneumonia, Diagnosis-Related Groups, Medicaid, Meaningful Use, Centers for Medicare and Medicaid Services, U.S., Electronic Health Records, Pulmonary Disease, Chronic Obstructive, Patient Readmission, Heart Failure, Medicare, Coronary Artery Bypass, Heart Valves, Prospective Payment System

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