CMS Announces Numerous Rule Changes

In early August, the Centers for Medicare & Medicaid Services (CMS) published an updated set of guidelines stating that hospitals will now be required to annually publish a list of charges online. CMS announced that the change in guidelines will “help improve access to hospital price information” and “give patients greater access to their health information.” However, hospitals are contending that the new guidelines may be problematic as they do not show prices after negotiating with insurance companies.  Jeffrey Bomme, the chief legal officer at Adventist Health System, commented on the new guidelines stating the charges will not be relevant to patients because the bill may be reduced or some services may have no charge due to a hospital’s charity policy. These reported prices may also mean that patients neglect needed care because of the listed price and not the price that they may have to pay out of pocket, says Tom Nickels, executive vice president for government affairs and public policy at the American Hospital Association. Yet, the CMS feels as though the new rule will “incentivize value-based, quality care at these facilities.”

Another finalization that CMS made was to the Inpatient Prospective Payment System (IPPS) that allows patients to access their health information using any application. However, providers contend that the “any application” portion creates a risk to patient information as it could be a point of entry for malware into the system. The CMS combatted this risk by stating there was no intention to imply that hospitals cannot take necessary measures to protect the privacy and security of patient information. Hospitals are allowed to vet application developers and such developers must register with the HHS to access online health records.

The CMS also eliminated the 25% rule, decreasing long-term care hospitals’ Medicare reimbursement rates. Originally, if more than 25% of long-term care patients came from one acute-care hospital, the long-term care hospital would be granted a reduced rate of approximately 50-60% less than what they would have otherwise received.  The CMS predicts that without the reduced rates, long-term care hospitals’ payments will increase by about .9% ($39 billion) and acute-care hospital payments will increase by about $4.8 billion.

Finally, CMS failed to eliminate duplicative penalties for hospital-acquired conditions.  Blair Childs, senior VP of public affairs for Premier, contends that CMS “missed an opportunity to…avoid duplication across programs by leaving the HAC penalties the same.”  Nonetheless, not all healthcare officials were offended by such a “missed opportunity.”

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Source: Modern Healthcare: Providers critical of CMS price transparency push in pay rule