The Centers for Medicare and Medicaid Services (CMS) released the 2027 Inpatient Prospective Payment System (IPPS) final rule on July 31. The rule includes a net increase to inpatient hospital payment of 2.3%, reflecting a 3.2% increase in the hospital market basket reduced 0.9% by the productivity adjustment.

The ACC commented on several policies now finalized by the rule.

• Despite objections from the ACC and other stakeholders, the New Technology Add-on Payment (NTAP) Alternative Pathway program for Breakthrough Devices will be repealed beginning with 2028 applications.
• Of 11 cardiovascular-related NTAP Alternative Pathway applications, three were withdrawn, seven were approved and one for the CARA System was denied.
• The WiSE®CRT system implant was reassigned from the Medical Severity-Diagnosis Related Group (MS-DRG) for Standard Pacemaker to the MS-DRG for Leadless Pacemaker, a move supported by the ACC.
• The Office of the National Coordinator for Health Information Technology (ONC) finalized the adoption of several updated HL7 FHIR® interoperability standards to support electronic prior authorization, the exchange of clinical and administrative data between payers and providers, patient access to payer data, and the sharing of drug formulary and provider directory information through standardized application programming interfaces.
• CMS finalized updates to hospital outcome measures, including Mortality (acute myocardial infarction [AMI], heart failure [HF] and CABG), Excess Days in Acute Care (AMI, HF), and Postoperative Venous Thromboembolism (VTE) measures, while retiring several legacy process measures. The mortality and excess days in acute care measures will add Medicare Advantage patients and use a shorter, two-year performance period, while the postoperative VTE measure will be added to the Hospital Inpatient Quality Reporting Program. The Discharged on Antithrombotic Therapy electronic clinical quality measure was retired.
• CMS continues to advance interoperability initiatives, including electronic prior authorization and unique device identifier (UDI) capture for implantable devices. The finalized rule makes the electronic prior authorization measure an optional bonus measure in 2027 and required starting in 2028, and adds the UDI for the Implantable Medical Devices measure to the Public Health and Clinical Data Exchange objective starting 2027.

For more information on the final rule, access CMS’ accompanying fact sheet and press release.

Clinical Topics: Cardiovascular Care Team

Keywords: Centers for Medicare and Medicaid Services, U.S., Prior Authorization, ACC Advocacy, Inpatients, Quality Indicators, Health Care, Health Care Technology, Hospitals, Diagnosis-Related Groups