CMS Issues Final IPPS Rule with Major Change for eCQM Reporting

On Tuesday, August 2, the Centers for Medicare & Medicaid Services (CMS) published the final rule for fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.


The Final Rule includes a major electronic Clinical Quality Measure (eCQM) reporting change: eligible hospitals will be required to report four quarters of data on an annual basis for eight of the available 15 eCQMs included in the Hospital Inpatient Quality Reporting (IQR) Program measure set for the FY 2019 (reporting year 2017) and FY 2020 (reporting year 2018) payment determinations in order to align with the Medicare and Medicaid EHR Incentive Programs.  This is a major change as the proposed rule required hospitals to electronically submit on all 15 eCQMs in the Hospital IQR Program.  Moreover, this means that we will not see measure reporting or measure set changes until the 2019 rulemaking (occurring during the spring/summer in 2018.)


The Final Rule also includes the addition of four new claims-based measures for the FY 2019 payment determination and subsequent years (three clinical episode-based payment measures and one communication and coordination-of-care measure). CMS is also finalizing the removal of 15 measures for the FY 2019 payment determination and subsequent years.  Of these 15 measures, 13 are eCQMs, two of which CMS is also removing in their chart-abstracted form, and two others are structural measures. 


In addition, it is important to note that inpatient hospitals that report quality data and are meaningful users of EHR technology will receive a 0.95 percent increase in their operating rates under Medicare.  For those hospitals that do not submit quality data, they would lose one-quarter of the full market basket update (2.7 percent).  Moreover, hospitals that are not meaningful EHR users are subject to a reduction of three-quarters of the FY 2017 market basket update.


For the Hospital Value-Based Purchasing (VBP) Program, CMS is finalizing updates to the Program requirements and the expansion of the Program measure set.


The Hospital Readmissions Reduction Program (HRRP) focuses on acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), total hip arthroplasty/total knee arthroplasty (THA/TKA), and coronary artery bypass graft (CABG) (pursuant to previous rulemaking).  The Final Rule seeks to align HRRP with other quality reporting programs and updates the public reporting policy so that excess readmission rates will be posted to the Hospital Compare website as soon as feasible following the hospitals’ preview period.