The Centers for Medicare & Medicaid Services (CMS) have proposed changes to empower patients through better access to hospital price information, improve patients' access to their electronic health records, and make it easier for providers to spend time with their patients. The proposed rule issued today proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

"We seek to ensure the healthcare system puts patients first," said Administrator Seema Verma. "Today's proposed rule demonstrates our commitment to patient access to high quality care while removing outdated and redundant regulations on providers. We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes. Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it."

The policies in the IPPS and LTCH PPS proposed rule would further advance the agency's priority of creating a patient-driven healthcare system by achieving greater price transparency and interoperability - essential components of value-based care - while also significantly reducing the burden for hospitals so they can operate with better flexibility and patients have the information they need to become active healthcare consumers.

While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.

The proposed policies released today begin implementing core pieces of the government-wide MyHealthEData initiative through several steps to strengthen interoperability or the sharing of healthcare data between providers. Specifically, CMS is proposing to overhaul the Medicare and Medicaid Electronic Health Record Incentive Programs (also known as the "Meaningful Use" program) to:

• make the program more flexible and less burdensome,
• emphasize measures that require the exchange of health information between providers and patients, and
• incentivize providers to make it easier for patients to obtain their medical records electronically.

To better reflect this new focus, we are re-naming the Meaningful Use program "Promoting Interoperability." In addition, the proposed rule reiterates the requirement for providers to use the 2015 Edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and avoid reductions to Medicare payments. This updated technology includes the use of application programming interfaces (APIs), which have the potential to improve the flow of information between providers and patients. Patients could collect their health information from multiple providers and potentially incorporate all of their health information into a single portal, application, program, or other software. This can support a patient's ability to share their information with another member of their care team or with a new doctor, which can reduce duplication and provide continuity of care. In the proposed rule, CMS is requesting stakeholder feedback through a Request for Information on the possibility of revising Conditions of Participation to revive interoperability as a way to increase electronic sharing of data by hospitals.

As part of its commitment to burden reduction, CMS is proposing in the FY 2019 IPPS/LTCH PPS proposed rule to remove unnecessary, redundant, and process-driven quality measures from a number of quality reporting and pay-for-performance programs. The proposed rule would eliminate a significant number of measures acute care hospitals are currently required to report and remove duplicative measures across the 5 hospital quality and value-based purchasing programs. This would result in the removal of a total of 19 measures from the programs and would de-duplicate another 21 measures while still maintaining meaningful measures of hospital quality and patient safety. Additionally, CMS is proposing a variety of other changes to reduce the number of hours providers spend on paperwork. CMS is proposing this new flexibility so that hospitals can spend more time providing care to their patients thereby improving the quality of care their patients receive.

In sum this results in the elimination of 25 total measures across the 5 programs with well over 2 million burden hours reduced for hospital providers impacted by the IPPS proposed rule, saving them $75 million.

For a fact sheet on the proposed rule (CMS-1694-P), please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-24.html

To view the proposed rule (CMS-1694-P), please visit: https://www.federalregister.gov/public-inspection/

STATEMENT ON PROPOSED FY 2019 IPPS RULE

Tom Nickels, Executive Vice President, American Hospital Association

April 24, 2018

CMS today took several steps that would help deliver on its promise to ease regulatory barriers and allow America's hospitals and health systems to better provide high-quality, efficient patient care. Last year, the AHA released a new analysis showing that providers spend nearly $39 billion a year solely on administrative activities related to regulatory compliance. The AHA appreciates the Administration working with the hospital field to reduce the administrative complexity of health care and allow providers to spend more time on patients, not paperwork.

Specifically, we are pleased that in today's proposed rule, the agency would permanently revoke the 25% Rule for long-term care hospitals. This will help ensure that patients get the care they need when they need it without facing arbitrary restrictions by non-patient-centered regulations. We are also encouraged that this year's rule begins to implement the Administration's "meaningful measures" initiative, a streamlined approach to quality measurement that can help ensure programs are focused on those core issues that are most critical to providing high-quality care and improving patient outcomes.

Additionally, the AHA is pleased that CMS has proposed a more flexible, performance-based approach to determine whether a hospital has met meaningful use requirements. CMS has also reduced burden by limiting the reporting periods to 90 days in 2019 and 2020. We are disappointed, however, that the agency will require use of 2015 Edition Certified EHR Technology beginning in 2019.