The Inpatient Prospective Payment System (IPPS) final rule for the 2017 fiscal year comes with some noteworthy elements, including requirements for new data collection, changes to several quality initiatives, and a change to the Two-Midnight rule.
The final IPPS rule will be effective for inpatient discharges taking place on and after Oct. 1, 2016. The final rule permanently removes the -0.2% payment cut related to the “two-midnight” payment policy established in 2014, a cut that has been controversial since its inception. To make up for what some providers have said were significant losses from that reduction, CMS also finalized an increase of about 0.8% for inpatient payment rates in an effort to offset the financial impact over the past three years. Not all of the changes were so beneficial to hospitals, however. The final rule almost doubles the reduction in payments related to documentation and coding overpayments, from -0.8% to -1.5%.
Quality data also becomes more important. Hospitals that do not submit quality data will lose 25% of the Market Basket update (2.7%), and hospitals that are not meaningful users of EHR could use 75% of the Market Basket update.
In addition, CMS is requiring hospitals to submit four quarters of data on eight of 15 electronic clinical quality measures (eCQM) as part of the Inpatient Quality Reporting (IQR) program. This data requirement begins in 2017 and includes such metrics as breast and cervical cancer screening statistics.
CMS also changed some Hospital-Acquired Conditions Reduction Program policies. One significant difference is that the program scoring methodology has been changed from current decile-based scoring to a continuous scoring methodology.
The final rule also addresses MS-DRG problems spawned by the transition from ICD-9-CM to ICD-10-CM/PCS. The transition resulted in a significant number of replication issues that resulted when mapping from ICD-9-CM to ICD-10-PCS. (For more information on the final rule and changes, go to http://go.cms.gov/1MFN9Po.)