Wednesday, April 25, 2018

Very Brief Blog: CMS Releases Proposed Version of INPATIENT FY2019 Rule

On April 24, 2019, CMS released the CMS inpatient proposed rule for 2019. 

Topics include (1) more transparency for hospital pricing, noting that a CMS policy not requires chargemaster to be "public" but the new policy would require them to be public, on the internet.

Two more topics include (2) policy incentives for EHR interoperability and (3) a large-scale streamlining of excessive reporting metrics and topics.  The term "burden" occurs 445 times in the 480 page rule.  As part of this burden reduction, CMS plans to drop nearly all hospital metrics that require chart abstraction for reporting.  (The only one left in 2021 will be SEP-1).

A number of the new tech add-on financial benefit requests this year are for costly new antibiotics.  Another looks at payment policy for CAR-T therapies, which may carry very high six-figure price tags. 
  • For the proposed rule, see Federal Register homepage here, May 7, 2018.
    • Access the COMMENT function from this page.
    • Published rule here, 83 Fed Reg 20164-20643, 480 pp.
  • For the CMS press release summary, see here.
SSA 1871 requires a 60 day comment period for CMS proposed rules.The official typeset version will appear in the Federal Register about May 7, the comment period will run until June 25.


The rule is about 475,000 words long, so about 1 of every 1000 words is "burden."
  • CMS has a dedicated website for reducing provider burden, here.  
  • CMS just held a national town hall on easing requirements for E&M documentation, here.  
  • CMS administrator Seema Verma regularly gives speeches on regulatory burden (herehere). 
  • These efforts truly carry out Executive Order 13771, which was signed by President Trump on January 30, 2017 and is devoted to reducing regulatory burdens (here, here). 
For comparison, the last Obama administration rule, for FY2017 (August 22, 2016; 81 FR 65762) was 650,000 words long and mentioned the term "burden" only 347 times.  That is only about once per 2000 words.

CMS has been looking at inaccuracy and other problems with chart-abstraction metrics for a while; see a 2017 effort here.