CMS Proposes Rule to Change Medicare Policy for Hospital Care


Proposed rule aims to increase transparency, flexibility, and innovation in care delivery.

The Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that would update Medicare payment and policies for patients admitted to hospitals for 2018.

The proposed mandate aims to reduce the regulatory burden on providers, support the patient-physician relationship, and promote transparency, flexibility, and innovation in care delivery, according to a press release.

The CMS is seeking to overhaul Medicare with a focus on patient-centric care, which allows providers to spend their time and resources improving patient outcomes, according to the press release.

The CMS is also calling for individuals to submit innovative ideas that will change regulations, policies, and practices to increase transparency, flexibility, and program simplification, according to the release. These concepts will be at the forefront of the conversation about future regulations for inpatient and long-term hospital stays, the CMS reported.

At this time, the CMS is proposing a 1-year regulatory postponement on the payment policy threshold for patient admissions in long-term care hospitals, while the policies continue to be evaluated, according to the release.

Additionally, the CMS is proposing to decrease clinical quality measure reporting mandates for hospitals that have implemented electronic health records (EHRs), with the goal of further reducing the administrative burden on physicians.

Under the proposal, hospitals that have implemented EHRs would receive an 1.6% increase in operating payment rates, according to the CMS. The rule would also change the hospital-acquired conditions reduction program to allow for more hospital input, including social risk factors and extraordinary exceptions.

The hospital readmissions program will be updated to base penalties on a hospital’s performance relative to hospitals that treat similar patients eligible for both Medicare and Medicaid.

Through the proposed payment rate increases and other policies, the CMS estimates that hospitals will see a 2.9% increase in inpatient operative prospective payments. However, under the proposed rule, long-term care hospital payments would decrease by 3.75%. These changes would affect approximately 3330 acute care hospitals and 420 long-term care hospitals, according to the CMS.

“Through this proposed rule, we want to reduce burdens for hospitals so they can focus on providing high quality care for patients,” said Seema Verma, CMS administrator. “Medicare is better able to support the work of dedicated hospitals and clinicians who provide the care that people need with these more flexible and simplified approaches."

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