On April 10, 2023, CMS has released inpatient rulemaking for FY2023. The agency now takes comment for 60 days. Then, the final rule typically appears 60 days ahead of the upcoming October 1 fiscal year.
See the Fact Sheet summary here. See the typical press release about the promised dramatic improvements in American health care based on this rule, here.
See the full rule (in preview typescript) here. This version weighs in at 1500 pages.
Come back for the typeset version on May 1.
SEP-1 Upgraded: Will Influence Dollars
As I've occasionally covered in this blog, CMS's inpatient hospital measure SEP-1 continues despite periodic pushback. However, on page 780 of the typescript, CMS proposes to newly position it as a Value Program (VBP) measure, giving it more financial weight than in the past. CMS notes that they had gotten both supportive and non supportive comments on this proposal. A January 2023 JAMA editorial specifically opined that making SEP-1 a dollar-weighed measure was not a good idea (here).
CMS notes, as it has for several years, that it continues to work on an electronically-based and survival-oriented measure (rather than a process- and chart-abstracted one).
CMS handled debate (see JAMA editorial above) about whether the measure is associated with improved outcomes by citing one paper finding improved outcomes (FN179, Townsend et al. 2021 Chest).
NTAP
CMS NTAP (new technology addon payment) discussions are lengthy as usual. However, CMS states they are "summarizing" and "providing more succinct" information in the rulemaking document. There were 27 NTAP applications (due in December). 8 withdrew and this year's rulemaking discusses 19 applications at page 299 fwd. The discussions are somewhat more tabular and readable than in the past. The first applicant (CYTALUX), runs from page 299 to 314 of the typescript. The NTAP applications as as whole run from 299 to 581, and include several novel antibiotics (which fall under NTAP but under a special subcategory of their own).
A diagnostic test asks for NTAP - SEPTICYTE, a two-molecular-marker test to distinguish infection sepsis from non infection sepsis (infection-negative SIRS). P. 416-426. The discussion is a good view of CMS thinking about diagnostics.
CMS includes a proposal (at page 581) to move up the required FDA approval date to May 1 (just a couple weeks after rule publication) rather than July 1 at present. They note that right now, "the increased volume and complexity of applications makes it more challenging to mitigate information gaps."
Bruce's Index to IPPS Rule
Using the finally published May 1 rule, here is my "cheat sheet" to pages.
II E Add on pmts NTAP
P 27776 PDF 119 Opens section
P26866 PDF 209 SeptiCyte
PDF 124 X codes
PDF 122 Addl pmt rules
PDF 298 QIDP Drugs
PDF 304 New FDA changes
PDF 306 END NTAP (26963)
V: J K L READM VBP HAC/HAI
P 27024 PDF 367
VBP New Measure SEP1 #0500 as a VBP rather than IRQ measure
P PDF 370 P 27027 [370-
HAC
P PDF 394 P 27051
IX C IRQ INPT QUAL REPORTING
P 27028 PDF 421
XI MEDPAC RECS
P 27190 pdf 533
See also IPPS rule Appendix B
