CMS Releases 2016 IPPS Proposed Rule

The Centers for Medicare and Medicaid Services (CMS) on April 17 released the FY 2016 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Proposed Rule. The rule updates the payment policies for discharges on or after Oct. 1, 2015. Highlights from the proposed rule include:

  • Payment rates for hospitals paid under the IPPS are expected to increase by 1.1 percent in FY 2016. This rate applies to hospitals that successfully participate in the Hospital Inpatient Quality Reporting Program (IQR) and are meaningful EHR users. Hospitals that do not successfully participate in the IQR and/or are not meaningful EHR users will be subject to a reduced update.
  • CMS seeks comment on expansion of the Bundled Payments for Care Initiative, including feedback developing appropriate episode of care definitions.
  • Although nothing is proposed in this rule, CMS is considering feedback from the Medicare Payment Advisory Commission and other stakeholders on withdrawing the two midnight rule, and will provide more detail in the Hospital Outpatient Prospective Payment proposed rule this summer.
  • CMS proposes several Medicare Severity Diagnosis Related Group (MS-DRG) updates addressing services such as automatic implantable cardioverter defibrillator generator procedures, procedures with drug-eluting stents and non-drug eluting stents, and abnormal aortic aneurysm repair. CMS also proposes MS-DRG updates based on ICD-10 changes.
  • CMS requests public comment on 2016 New Technology Add-On Payments, including the continuation of add-on payments for the CardioMEMS heart failure monitoring system and MitraClip, and new add-on payments for the Diamondback 360 coronary orbital atherectomy system, Lutonix drug coated balloon and In.PACT Admiral balloon catheter, and the Watchman left atrial appendage closure device.

As with each IPPS rule, CMS also proposes measure updates to the Hospital IQR, Hospital Value-Based Purchasing Program, Hospital Readmissions Reduction Program, and other hospital quality programs under the IPPS. The ACC is reviewing the rule in more detail and will provide more information on provisions affecting cardiovascular services. The College will also prepare comments with input from relevant committees/councils and other societies. 

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: Atrial Appendage, Centers for Medicare and Medicaid Services (U.S.), Defibrillators, Implantable, Diagnosis-Related Groups, Drug-Eluting Stents, Episode of Care, Heart Failure, Inpatients, International Classification of Diseases, Long-Term Care, Medicaid, Medicare, Medicare Payment Advisory Commission, Outpatients, Patient Discharge, Patient Readmission, Prospective Payment System, Prospective Studies, Value-Based Purchasing

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