CMS Releases 2021 Hospital Inpatient Prospective Payment System Proposed Rule

Price transparency, graduate medical education, and changes to the Hospital Inpatient Quality Reporting (IQR) Program and to the Medicare and Medicaid Promoting Interoperability Programs are part of the proposed 2021 Hospital Inpatient Prospective Payment System Proposed (IPPS) rule released by the Centers for Medicare and Medicaid Services (CMS).

Based on the annual hospital payment update and policies in the proposed rule, CMS estimates that hospitals paid under the IPPS that successfully participate in the Inpatient Quality Reporting Program and are meaningful electronic health record (EHR) users could see a 3.10 percent payment increase in FY 2021. The proposed rule also addresses the Hospital Readmissions Reduction Program and includes postponement of the updated Overall Hospital Quality Star Rating methodology. Modifications to the MS-DRG assignments for left atrial appendage closures, endovascular cardiac valve replacement and supplement procedures, and insertion of cardiac contractility modulation device are also included. The proposed rule does not include any changes to measures from the Hospital Value-Based Purchasing Program.

While ACC Advocacy leaders and staff are reviewing the proposed rule in closer detail to assess the impact of these proposals, additional highlights of the proposed rule include:

Price Transparency

Under the proposed rule, hospitals would be required to report certain market-based payment rates on their Medicare cost report for cost reporting periods ending on or after Jan. 1, 2021, with the goal of aiding the development of a market-based approach to payment under the Medicare Fee-For-Service system. This would be a potential change to the methodology for calculating the IPPS MS-DRG relative weights to reflect relative market-based pricing. CMS aims to collect data on the median charges that hospitals negotiate with Medicare Advantage plans and third-party payers for inpatient services — a policy in line with the Hospital Price Transparency Final Rule (84 FR 65524) released last year.

New Technology Add-On Payments for Certain Antimicrobial Products

CMS is proposing to expand the alternative new technology add-on payment pathway for antimicrobial products designated by the U.S Food and Drug Administration (FDA) as qualified infectious disease products (QIDPs) to include products approved under FDA's Limited Population Pathway for Antibacterial and Antifungal Drugs (LPAD pathway). The rule also proposes providing conditional approval for antimicrobial products that otherwise meet the NTAP alternative pathway criteria but do not receive FDA approval in time for consideration in the final rule. More details are spelled out in the CMS FAQ.

Graduate Medical Education Policy

In an effort to address the needs of residents affected by closing teaching hospitals and closing residency programs and who are attempting to find alternative hospitals in which to complete their training, the proposed rule expands the existing definition of who is considered a displaced resident beyond residents who are physically present at the hospital training on the day prior to or the day of hospital or program closure. Additionally, CMS would allow funding to be transferred for certain residents who are not physically at the closing hospital/closing program.

Hospital Inpatient Quality Reporting (IQR) Program

The proposed rule contains several measures related to the Hospital IQR program, including the start of publicly displaying electronic clinical quality measures (eCQMs) data on the Hospital Compare website. It also proposes changes to reporting and public reporting of eCQMs and the current validation process. Additionally, CMS plans to progressively increase the number of quarters of eCQM data reported, from one self-selected quarter of data to four quarters of data between 2021 and 2023. Read more.

Medicare and Medicaid Promoting Interoperability Programs

CMS has proposed an electronic health record (EHR) reporting period of a minimum of any continuous 90-day period in CY 2022 for new and returning participants (eligible hospitals and CAHs) in the Medicare Promoting Interoperability Program attesting to CMS. The Agency is also seeking public comment on progressively increasing the number of quarters hospitals are required to report eCQM data between 2021 and 2023. Additionally, CMS is seeking to publicly report eCQM performance data for the first time, beginning with data reported for the CY 2021 reporting period, on Hospital Compare and/or data.medicare.gov, or any successor websites.

The ACC plans to submit comments to CMS in response to the proposed rule by the July 10 public comment deadline. The College will continue to actively monitor any further developments to these proposals and others affecting cardiovascular care. Access a full breakdown of the proposed rule through this CMS Fact Sheet.

Keywords: ACC Advocacy, Insurance, Health, Reimbursement, Centers for Medicare and Medicaid Services (U.S.), Medicaid


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