On Aug. 2, the Centers for Medicare and Medicaid Services (CMS) issued the final rule on the fiscal year 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS).

In late June, the ACC commented on the proposed rule, addressing several changes to medical severity diagnosis related groups – as well as several health IT proposals and requests for information.

In response, the final rule includes the following highlights:

• Peripheral Extracorporeal Membrane Oxygenation (ECMO) codes reassigned to MS-DRG 003 with central ECMO, though peripheral ECMO will still be designated non-O.R.;
• Changes to reduce severity factor STEMI and congestive heart failure as secondary diagnoses were not finalized;
• Finalization of the 90-day reporting period for calendar year 2021 promoting interoperability;
• Increases to the wage index for certain low-wage index hospitals, including many rural hospitals, though offset through budget neutrality to the entire system rather than only to hospitals in the top 25 percent of wage indices;
• Increases to Medicare add-on payments for high cost eligible new technologies from 50 to 65 percent;
• Clarifications on policies regarding "substantial clinical improvement" to qualify for new technology add on payments;
• Alternative pathways where breakthrough devices are no longer required to demonstrate evidence of "substantial clinical improvement" to qualify for new technology add-on payments;
• Alternative pathways where qualified infectious disease products are no longer required to meet the "substantial clinical improvement" criteria for technology add-on payments, which are increased from 50 to 75 percent.

“The inpatient rule contains many proposals that impact care of cardiovascular patients,” commented Marvin A. Konstam, MD, FACC, member of ACC’s Health Affairs Committee. “It was encouraging to see CMS adapt course from last year on its approach to ECMO payment back to appropriate levels.”

The ACC is reviewing the rule in more detail and will provide more information in the coming weeks. For more information, review the CMS 2020 IPPS final rule and fact sheet.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Hospitals, Rural, Extracorporeal Membrane Oxygenation, Myocardial Infarction, Inpatients, Prospective Payment System, Medicare, Medicaid, Diagnosis-Related Groups, Heart Failure, Salaries and Fringe Benefits

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