2020 IPPS Final Rule: 10 Things to Know

The reporting requirements for the IQR program largely remain the same over the next few years but CMS has added one new opioid eCQM. Here is what you need to know.

• For 2020 and 2021 you still only have to report one quarter of data for four eCQMs.
• In 2022, you still only have to do one quarter of data for four eCQMs, but one of those eCQMs must be the proposed Safe Use of Opioids – Concurrent Prescribing eCQM.

CMS is making the Hybrid measure a part of your IQR requirements by 2024. It will start with two voluntary reporting periods, July 1, 2021 - June 30, 2022, and July 1, 2022 - June 30, 2023, before making the measure a requirement in 2024.

Keep in mind that the voluntary submissions for the Hybrid HWR measure will have no impact on your Medicare payment determination. As part of the pilot program in 2018, CMS received 150 voluntary hybrid submissions—and a whopping 69 of those were submitted by Medisolv on behalf of our clients!

Also see: Understanding the Hybrid Readmission Measure blog

Starting in 2020, CMS will use the same data as the HAC program to calculate HAI measures in the HVBP program.

Note that these NSHN measures will no longer be a part of the Hospital IQR program in 2020.

Beginning next year, CMS plans to remove the Verify Opioid Treatment Agreement measure from the Promoting Interoperability (PI) program, formerly known as the Meaningful Use program, after receiving feedback from stakeholders that the measure was burdensome and challenging to implement.

CMS will also keep the Query of Prescription Drug Monitoring Program measure as optional for bonus points in the PI program. In 2019, CMS had previously finalized that the measure would be required, but they’ve changed that requirement in this rule.

CMS will adopt eight new measure removal factors for the HRRP and the HAC programs. These measure removal factors would align with the measure removal factors that have already been implemented for the Inpatient Quality Reporting (IQR) and Hospital Value-Based Purchasing (VPB) programs. You can read about the eight measure removal factors in this blog that explains how this affects the IQR program in 2019 and beyond.

CMS plans to address the wage index discrepancies between rural and urban hospitals by increasing the wage index values for low-wage hospitals below the 25th percentile. They will increase it by half the difference of the wage index value for that hospital versus the 25th percentile wage index value of all hospitals.

Unlike in the proposed rule, they will not be decreasing the wage index values for high-wage hospitals above the 75th percentile. Instead all hospitals will share this burden, but it will be capped at 5% of wage index value. This policy will be effective for at least four years starting next year.

CMS is expediting the development and review of “transformative new drugs and devices.” Under this rule, once the FDA provides “marketing authorization” for one of these medical devices that are in the expedited program then they receive the new technology add-on payment (as long as they meet the cost criterion).

Also new for new technology add-on payment calculations, CMS will increase the add-on payment from 50% to 65% for FY 2020. Medicare believes that paying only up to 50% of the cost of new medical technology doesn’t meet the high costs associated with these new technologies.

Next year, the operating payment rate for hospitals that successfully report to the Hospital IQR program and are meaningful EHR users will increase by 3.1%. CMS estimates this to mean a $3.8 billion total increase for 2020.

Each year CMS distributes funds to hospitals who care for more uninsured patients. They call them “disproportionate share hospitals.” CMS projects that it will distribute $8.4 billion in uncompensated care payments in FY 2020, which is an increase of $78 million over last year.