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In case you missed it: Our take on the IPPS proposed rule for 2019

June 13, 2018

    In late April, CMS released the Hospital Inpatient Prospective Payment System Proposed Rule for FY 2019. In addition to proposed headline rate and total payment increases (of 1.75% and 2.1%, respectively) the rule contains a notable shift in policy on price transparency and a significant restructuring of quality reporting. Providers still have time to contact CMS to respond to the rule before it is finalized. The 60-day comment period comes to a close on June 25 at 5pm EST.

    Below are three of our top takeaways from the Proposed Rule:

    1. This is your chance to influence developing policies on price transparency and quality reporting

    2. Although the changes in price transparency will not cause most providers headaches, the scope of the requests for public feedback indicates that future price transparency regulation could be much more disruptive. Likewise, newly proposed quality reporting standards contain significantly divergent methodological variants. Now is the opportunity for providers to make their voices heard.

    3. Proposed reduction in quality measures not likely to significantly reduce reporting burden

    4. The proposals to restructure quality reporting will not reduce reporting burden as significantly as they may appear to. Nine of the 10 measures to be struck from VBP must still be reported for the IQR or HAC programs. Other measures slated for removal are taken from the EHR or are claims based, requiring little provider effort.

    5. Expect further MS-DRG classification changes in future as CMS reviews CC/MCC and OR codes

    6. Compared with last year, the FY 2019 proposed rule contains few changes to grouper logic and treatment of ICD-10 codes, resulting in a relatively calm year for volume shifts. But CMS statements suggest that significant reclassification is still underway and may be reflected in future years' rules.

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