While hospitals have focused on the proposed price transparency requirements of CMS' much-anticipated payment rule for Medicare inpatient hospital services, several other provisions in the rule could affect hospital operations.
- Public reporting of electronic clinical quality measures. Starting in the calendar year 2021, CMS wants to display eCQM information on its Hospital Compare website. It's part of the Trump administration's push to increase quality transparency and consumerism in healthcare. Hospitals would also have to gradually increase the number of quarters that they report eCQM data over three years, from one self-selected quarter to all four quarters by the calendar year 2023.
- Streamlined validation process for the inpatient quality reporting program. Under proposed changes to the validation process for the inpatient quality reporting program, hospitals would have to submit their chart abstracted measures electronically. Providers wouldn't be able to submit paper records, CDs, DVDs, flash drives or other physical copies. CMS also wants to cut the number of hospitals it selects for validation by half and merge the validation processes for chart abstracted measures and eCQMs.
- Increased use of Certified EHRs for quality reporting. CMS wants hospitals to use certified electronic health record systems to submit data for all hybrid measures under its hospital inpatient quality reporting program, not just the hybrid hospital-wide 30-day readmission measure it rolled out in last year's IPPS rule. Hybrid measures combine claims data and so-called "core clinical data elements" like patient vital signs and lab results to adjust for patient risk. Conventional quality measures only use claims data.
- New requirement to report negotiated rates by diagnosis-related group. Under the rule, hospitals would have to report the median of payer-specific negotiated rates by DRG on their Medicare cost report. The agency believes that it will be relatively easy for hospitals to calculate and report median payer-specific negotiated charges since they already have to publicly report their negotiated charges under the hospital price transparency rule. Hospitals sued HHS over the price transparency rule and the loser of the case is likely to appeal the decision.
- Changes to medical residency funding. CMS is proposing changes that would make it easier for residents to keep their Medicare funding if a teaching hospital or residency program shuts down. The changes would peg residents' funding to the announcement of the closure rather than the effective date of the closure like under current law. Residents would no longer have to wait until the hospital or program closes to maintain their funding. Likewise, residents that planned to train—or return to train—at a closing hospital or program could retain their funding, even if they weren't onsite when the closure was announced. Residents were hung out to dry when a Philadelphia teaching hospital shut in 2019.
