Proposed rules would advance administrative burden reduction, Medicare modernization, and the Meaningful Measures Initiative
Today, the Centers for Medicare & Medicaid Services (CMS) proposed transformative changes to the payment systems for services furnished by a range of medical facilities. The agency’s proposed payment rules also set out to continue to modernize Medicare through innovation in skilled nursing facility payment to drive value, advance meaningful quality measure reporting, and reduce paperwork and administrative costs.
“We envision all elements of CMS’ healthcare delivery system working to reward value over volume and decisively focus on patients receiving quality care from their Medicare benefits,” said Administrator Seema Verma. “For skilled nursing facilities, we are taking important steps through proposed payment improvements that will reduce administrative burden, and foster innovation to improve care and quality for patients. As people face rising healthcare costs in other clinical settings, we need to leverage advances in technology that help to modernize our programs in a way that benefits patients.”
The proposed payment rules issued today will update Medicare policies and rates under the Skilled Nursing Facilities Prospective Payment System (SNF PPS), Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS), Hospice Wage Index and Payment Rate Update, and Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). These payment policy proposals for Fiscal Year 2019 further advance the agency’s priority of creating a patient-driven healthcare system that fosters innovation of efficient and accountable programs while removing waste, fraud, and abuse.
As part of the SNF PPS, the agency is proposing a Patient Driven Payment Model (PDPM), an innovative new system for SNF payment that ties payment to patients’ conditions and care needs rather than volume of services provided. PDPM would simplify complicated paperwork requirements for performing patient assessments by significantly reducing reporting burden, savings facilities approximately $2.0 billion over 10 years. The proposed new PDPM is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives, which requires substantial paperwork to track over time. This approach advances CMS’ efforts to build a patient-driven healthcare system beginning with innovation throughout Medicare’s payment systems. Under the new SNF PPS case-mix model, patients will have more opportunity to choose a skilled nursing facility that offers services tailored to their condition and preferences, as the payment to nursing homes will be more based on the patient’s condition rather than the specific services provided by each skilled nursing facility.
In the proposed rules announced today, the agency is also responding to comments from stakeholders and seeking to incorporate its Patients over Paperwork Initiative through avenues that reduce unnecessary burden on providers by easing documentation requirements and offering more flexibility. In SNF settings, the proposed new case-mix model, PDPM, is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives. Today’s IRF PPS rule reflects advances in telecommunications technology and would remove obstacles that may prevent rehabilitation physicians from conducting certain meetings without being physically in the room. For these facilities, the rules would also remove overly prescriptive documentation requirements for admission orders.
“We are taking action in the following proposed rules to reduce paperwork, while maintaining patient safety and program integrity by focusing on meaningful measures,” Verma said.
Taken together, the modernizing proposals to advance CMS’ Meaningful Measures Initiative released today and the proposals in the recently released FY 2019 Hospital Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) proposed rule are projected to save providers close to four million hours and more than $144 million as they take effect in 2019 and 2020.
Proposed rules for updating Medicare policies and payments under both inpatient rehabilitation and inpatient psychiatric facilities include proposed removal of certain measures. Patient safety and program quality and integrity are top priorities for the agency and are the core of the meaningful measures initiative. The IRF and IPF proposed rules released today include measures that are patient-centered and outcome-driven rather than process-oriented. Where applicable, these changes will allow providers to work with a smaller set of more meaningful healthcare measures and spend more time on patient care.
Advancing My HealthEData: Request for Information from stakeholders
In addition to payment and policy proposals, CMS is releasing a Request for Information (RFI) to obtain feedback on positive solutions to better achieve interoperability or the sharing of healthcare data between providers. Specifically, CMS is requesting stakeholder feedback through an RFI on the possibility of revising Conditions of Participation related to interoperability as a way to increase electronic sharing of data by providers. This will inform next steps to advance this critical initiative.
In responding to the RFI, commenters should provide clear and concise proposals that include data and specific examples. CMS will not respond to RFI comment submissions in the final rule, but rather will actively consider all input in developing future regulatory proposals or future sub-regulatory guidance.
To view the Fiscal Year 2019 proposed rules posted today at the Federal Register and a CMS fact sheet on each of the proposed rules, please visit the appropriate links:
- Skilled Nursing Facility Prospective Payment System (SNF PPS) (CMS-1696-P), please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-09015.pdf ; see the CMS SNF PPS Fact Sheet at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-27-4.html
- Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS), (CMS-1688-P), please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-08961.pdf; see the CMS IRF PPS fact sheet at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-27.html
- Hospice Wage Index and Payment Rate Update, (CMS-1692-P), please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-08773.pdf; see the CMS Hospice Wage Index & Payment fact sheet at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-27-3.html
- Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) (CMS-1690-P), please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-09069.pdf; see the CMS IPF fact sheet at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-27-2.html