The Centers for Medicare and Medicaid Services (CMS) on April 18 released the fiscal year (FY) 2023 proposed Inpatient Prospective Payment (IPPS) Rule. The proposed rule includes the following highlights:

• Increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality-Reporting (IQR) Program, projected to be 3.2%

• Proposes to modify the calculations of the FY 2023 Medicare Severity Diagnosis-Related Group (MS-DRG) relative weights to account for anticipated decline in COVID-19 cases in 2023. This will be done by calculating the data twice – once with COVID-19 claims and once without – and then averaging the two sets. 

• Solicits comments on how reporting of social determinants of health can improve the utilization of resources under MS-DRGs

• Payment adjustments to incentivize purchase of fully domestically produced N95 masks

• Proposes 5% cap on wage index decreases for hospitals to reduce volatility

• Proposes 10 new measures to be added to the Hospital IQR Program

• Refinement of two existing IQR measures, one being excess days in acute care after hospitalization for acute myocardial infarction

• Updates to Medicare’s Promoting Interoperability Program 

• Suppression or refinement of certain policies within the Hospital Readmissions Reduction Program, Hospital-Acquired Condition Reduction Program and Hospital Value-Based Purchasing Program to neither reward nor penalize hospitals based on circumstances caused by the COVID-19 public health emergency 

Read the full proposed rule here, view a CMS fact sheet here, and view a CMS maternal care-specific fact sheet here. 

ACC staff are reviewing the rule to identify any additional topics of interest and will provide more information after further review, and will submit comments to CMS with input from relevant committees/councils and other societies.

Clinical Topics: COVID-19 Hub

Keywords: Prospective Payment System, SARS-CoV-2, Policy, Diagnosis-Related Groups, Myocardial Infarction, Iatrogenic Disease, Hospitals, Medicare, Social Determinants of Health, N95 Respirators, COVID-19, Inpatients, Patient Readmission, Value-Based Purchasing, Value-Based Purchasing, Centers for Medicare and Medicaid Services, U.S., ACC Advocacy

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