Expanding the Pipeline: Congress Considers Residency Legislation

It is a fundamental of physics: a narrow funnel can inhibit the rate of flow. Consider, if you will, the hourglass. You can have a pound of sand at the top that would quickly fall and fill the cavernous section at the bottom if it weren’t for that narrow passageway connecting the upper and lower chambers of the glass. Similarly, it is clear that the wider your waterline or expanded your gas line, the quicker you can count on larger quantities getting to their designated destinations. Unlike our waistlines—in this context—wider is better.

Pinpointing the Problem

We have a pipeline problem when it comes to a specific segment of the medical provider community. We have addressed on more than one occasion in recent months the nursing shortage crisis, especially as it affects hospitals. Those with a pedantic penchant might more precisely point out that there is not a shortage of RNs in the country; rather they just aren’t showing up in our hospitals in sufficient numbers. They’re either in other clinical capacities or working in different careers or not working at all. We would be remiss, however, if we did not point out at this juncture that there is a physician shortage in this country, as well.

Long before the ravages of COVID, many labeled the dwindling numbers of doctors to patients as a crisis. Indeed, according to a recent study from the Association of American Medical Colleges (AAMC), the United States is facing a shortage of up to 124,000 physicians. With the continuing aging of the U.S. population, this troublesome trend is threatening to only get more acute.

One reason consistently given over the last few years for the doctor shortage crisis is the lack of residency programs and positions available for prospective physicians. Remember our opening discussion of the hourglass with its narrow funnel? This is analogous to what’s happening with the current distribution of doctors across the United States. Regardless of how many individuals are seeking to go into the medical profession, if there is a bottleneck in the availability of residency positions, this limits the number of current and future physicians available to staff our nation’s hospitals.

Working toward a Solution

In an effort to address this component of the crisis, a bill was introduced in the U.S. Senate this spring that seeks to widen the pipeline for new doctors. The Resident Physician Shortage Reduction Act of 2023 contains provisions that will greatly expand residency positions. Specifically, the legislation would combat the nation’s current and projected shortage of physicians, as well as improve access to healthcare, by expanding the number of Medicare-supported medical residency positions by 14,000 over seven years. To put it another way, the bill provides for an additional increase of 2,000 positions per fiscal year, from FY2023-FY2029. During this period, each hospital may receive up to 75 additional positions in total under the bill in combination with current law.

The bill’s introduction met with widespread approval from several quarters, including the American Hospital Association (AHA). A letter written to the bill’s sponsors was effusive in its praise of the pending legislation. The following is an excerpt from the AHA letter:

Thanks to your leadership, Congress provided 1,000 new Medicare-supported GME positions at the end of 2020 and 200 additional positions in 2022 – the first increases of their kind in more than 25 years. Your legislation would build on Congress’ historic investment by increasing the number of Medicare-supported residency positions by 2,000 each year for seven years, for a total of 14,000 new slots. A portion of these positions would be targeted for hospitals already training over their caps, hospitals in rural areas, hospitals in states with new medical schools or branch campuses, and hospitals serving areas designated as health professional shortage areas.

So, it looks as if the spigot is being turned on and the pipeline will be widened to allow for a greater influx of physicians heading to our nation’s hospitals. While this may not be the silver bullet that provides a comprehensive solution to the long-term doctor shortage crisis, it is at least a good start. It remains to be seen, however, if increasing the number of residency slots, alone, will be enough to keep up with the surging Medicare population, as well as the yearly growth in the general population. The sands of time will tell.

from
https://www.coronishealth.com/blog/expanding-the-pipeline-congress-considers-residency-legislation/

Challenging the IPPS Proposed Rule: U.S. Senators Request a Hike in Hospital Pay

Government intrigue; agency versus agency—these are the themes that underpin many a Tom Clancy novel or John Frankenheimer film. Political infighting, however, is not just relegated to the realm of fiction; often, the real world provides glimpses of government heavyweights going after each other in a test of political wills and ideological strength. While not exactly the stuff of Woodward and Bernstein, a recent pushback by one branch of the U.S. government against another is offering at least a modicum of melodrama for those on the outside looking in—especially for those in the hospital community.

The American Hospital Association (AHA) is reporting that a letter was sent by a group of United States senators to the head of the Centers for Medicare and Medicaid Services (CMS) that, in effect, challenges the payment update for hospitals as found in CMS’ fiscal year (FY) 2024 Inpatient Prospective Payment System (IPPS) Proposed Rule (PR). The letter, dated June 12 and addressed to CMS Administrator Chiquita Brooks-LaSure, urged the agency to upwardly revise the reimbursement rate listed in the PR.

Strong Support

Significantly, the communication to CMS was signed by a bipartisan group of 34 senators. That’s a potent array of powerbrokers in Washington that the CMS administrator cannot easily ignore. The senators officially requested Brooks-LaSure to reevaluate the proposed payment update over concerns that the reimbursement rate being proposed does not fully account for the current cost of care, which the senators believe will result in an overall payment reduction for hospitals in FY 2024. Here is how the senators’ letter opens:

We write today to express our concern regarding the proposed payment updates included in the Centers for Medicare & Medicaid Services’ (CMS) inpatient prospective payment system (IPPS) proposed rule for fiscal year (FY) 2024. We are concerned that the proposed payment updates do not fully account for the current cost of care and will result in an overall payment reduction for hospitals in FY2024. We request CMS consider using its special exceptions and adjustments authority to update the proposed payment update in the final IPPS rule.

So, two things jump out at us as it pertains to this introductory paragraph. First, there is an expressed concern that hospital payments will be inadequate given the current cost of care, i.e., inflation of supplies, human resources, etc. Second, the senators point to a certain leeway available to CMS that could allow the agency to increase the payment rate as currently proposed.

Rationale for Support

The senators’ request for an increase in the IPPS payment from the current proposed rates does not seem, at least on the surface, to be arbitrary or based on a mere desire to assuage a particular special interest group for political gain. Rather, the reasoning expressed by the legislators for their request is based on what they assert to be a misguided formula currently employed by CMS to calculate an appropriate payment rate. The letter goes on to note the following:

In the FY2024 proposed rule, CMS relies on historical data that does not predict the impact of the current elevated cost of providing care and the increased growth in expenses due to labor and supply chain costs. Additionally, the productivity update included in the proposed rule assumes hospitals can replicate the general economy’s productivity gains. However, in reality the critical financial pressures that hospitals and health systems continue to face have resulted in productivity declines, not gains.

Though the letter does not cite specific data that conflicts with CMS estimates, the point is nevertheless made: these 34 senators believe CMS is using an inadequate methodology for determining a reasonable IPPS rate for the nation’s hospitals. They specifically point to the importance of ensuring that the requested retrospective adjustment “account for the difference between the market basket update that was implemented for FY 2022 and what the market basket actually is for FY 2022.”

We will have to wait and see if this appeal from the legislative branch to the executive branch will have any effect on decision-making over at CMS. However, no one can easily ignore the weightiness of those making the request. After all, these are some of the same individuals who have oversight and spending authority over CMS’ programs. Though not exactly a political thriller, there is at least some drama in seeing which government branch will ultimately have the political muscle to enforce its will on the other, with the hopes and wellbeing of America’s hospitals left hanging in the balance.

from
https://www.coronishealth.com/blog/challenging-the-ipps-proposed-rule-u-s-senators-request-a-hike-in-hospital-pay/

Navigating United Healthcares Recent Colonoscopy Charges Changes

The recent changes to UnitedHealthcare’s colonoscopy coverage have sent shockwaves through the medical community. Gastroenterologists and patients alike are grappling with the implementation of a controversial process called prior authorization, which has the potential to create barriers to essential diagnostic and surveillance colonoscopies.

The Impact of UnitedHealthcare’s Policy

UnitedHealthcare’s decision to require prior authorization for colonoscopies, effective June 1, 2023, has left gastroenterologists bewildered and concerned.

Under this new policy, patients seeking surveillance and diagnostic colonoscopies must obtain approval from UnitedHealthcare or face out-of-pocket expenses. Physicians fear that this requirement will hinder timely access to endoscopic procedures, particularly those for cancer detection, which constitute a significant portion of gastroenterologists’ workload.

Challenges and Consequences of a Major Policy Change

Physicians across the country have expressed serious worries about the adverse effects of prior authorization on patient care. The process often leads to delays and denials of necessary treatments, resulting in potentially serious consequences, such as:

• Treatment Delays: Prior authorization can result in significant delays in patients receiving necessary treatments. The approval process can be time-consuming, requiring multiple steps and documentation, leading to a prolonged wait for patients. 

• Decreased Patient Compliance: Patients may become overwhelmed by the administrative burden and the uncertainty of whether their treatment will be approved. This can result in decreased patient compliance and adherence to recommended treatments, potentially compromising their health outcomes.

• Disruption of Continuity of Care: If a treatment or medication is denied due to prior authorization, patients may need to switch to an alternative treatment plan. This interruption can lead to discontinuity in the management of their condition and impact their overall healthcare experience.

• Adverse Health Outcomes: Conditions that require timely intervention, such as cancer or chronic diseases, may worsen if treatment is delayed or denied. This can lead to increased morbidity, complications, and potentially even life-threatening situations.

• Increased Administrative Burden on Physicians: Physicians and their staff often bear the brunt of the administrative burden associated with prior authorization. They must navigate complex paperwork, provide additional documentation, and spend valuable time communicating with insurance companies to obtain approvals. This increased administrative workload can take away time and resources from direct patient care.

• Financial Strain on Patients: Patients may be responsible for the full cost out-of-pocket or may need to pursue lengthy appeals processes if treatments or procedures are denied. This can lead to financial stress, potential debt, and limited access to necessary care for those who cannot afford the expenses.

• Decreased Patient Satisfaction: The frustration and difficulties associated with prior authorization can erode trust between patients and healthcare providers.

Patients with concerning symptoms or undiagnosed cancer may face prolonged waiting periods for approval, exacerbating their conditions and leading to devastating outcomes. Moreover, the timing of UnitedHealthcare’s announcement, coinciding with Colorectal Cancer Awareness Month, has been seen as tone-deaf and offensive by healthcare professionals.

The Complexities of Prior Authorization

While prior authorization aims to control overspending in healthcare, its execution often presents complications. Physicians and patients have long struggled with a convoluted process involving insurance employees lacking medical training. It frequently leads to delays, denials, and increased administrative burdens for medical practices. 

Appeals and peer-to-peer calls further extend the timeline, leaving patients in limbo. With UnitedHealthcare’s prior authorization policy, patients may face additional barriers to completing colonoscopies, discouraging them from pursuing vital screenings.

The Impact on High-Risk Patients

The new policy exempts screening colonoscopies for low-risk individuals but requires prior authorization for diagnostic and surveillance colonoscopies. This distinction fails to alleviate concerns among gastroenterologists. High-risk patients, who require more intensive screening strategies, will now face additional obstacles to accessing crucial procedures. For patients with a history of polyps or genetic predispositions to colorectal cancer, regular surveillance is a matter of life and death. Delayed or denied authorizations can have severe consequences, potentially worsening disparities and patient outcomes.

Outsourcing Revenue Cycle Management to Navigate Colonoscopy Coverage Changes

Amidst these challenges, Coronis Health stands ready to support physicians and medical practices in adapting to UnitedHealthcare’s colonoscopy coverage changes. With expertise in revenue cycle management, medical billing, and medical coding, Coronis Health helps streamline administrative processes and navigate the complexities of prior authorization. Our team of professionals understands the unique needs of healthcare providers and can provide tailored solutions to ensure prompt access to necessary colonoscopies for patients.

Contact us today and schedule a no-cost financial health checkup to find out how we can help your practice thrive in healthcare’s ever-evolving landscape.

from
https://www.coronishealth.com/blog/navigating-united-healthcares-recent-colonoscopy-charges-changes/

Under Attack: Hospitals Face New Cybersecurity Threats

In 1544, the French stronghold of Boulogne was besieged by 36,000 English troops under the orders of King Henry VIII. The town was considered impregnable, with its double row of reinforced ramparts. However, after undergoing a withering barrage of canon fire and suffering an explosion set within an underground chamber that had been surreptitiously dug by the English, the walls fell; and the city was forced to surrender.

Sometimes, things just don’t go your way. It matters not what preparations you’ve made or what precautions you’ve taken, an ingenious enemy has the capability of countering your defenses. That is certainly true in the context of the modern healthcare facility. Bad actors (and, here, we’re not talking about B-movie role players) are always present and looking for an in. They would like nothing more than to breach a hospital’s security shield in order to carry out their nefarious intentions—whether that be stealing patient data or shutting down vital systems for ransom purpose or causing general havoc for nothing more than kicks and giggles.

Unmasking the Bandits

Recently, Becker’s Health IT compiled a list of the latest threats now underway against the American healthcare system. These hack-happy organizations were originally identified in a June 8 briefing given by the Health Sector Cybersecurity Coordination Center. The current threats are as follows:

• LockBit 3.0. This is group that operates as a ransomware-as-a-service model. It is financially motivated and is alleged to have ties with individuals or entities in Russia. According to the U.S. Cybersecurity and Infrastructure Security Agency (CISA):

LockBit 3.0 attempts to spread across a victim network by using a preconfigured list of credentials hardcoded at compilation time or a compromised local account with elevated privileges. When compiled, LockBit 3.0 may also enable options for spreading via Group Policy Objects and PsExec using the Server Message Block (SMB) protocol. LockBit 3.0 attempts to encrypt [T1486] data saved to any local or remote device, but skips files associated with core system functions.

• Clop. This ransomware gang claimed to have breached Community Health Systems, headquartered in Franklin, Tennessee. This is the same organization that is believed to have been behind the recent MOVEit Transfer data-theft attacks, where a so-called “zero-day” vulnerability was exploited to breach servers belonging to “hundreds of companies” and to steal their data. Interestingly, the ransomware gang confirmed to representatives at BleepingComputer that they have yet to initiate the extortion process. Instead, they are likely to take some time to review the compromised data and determine what is valuable and how it could be used to leverage a ransom demand from breached companies. In their previous computer caper, there was a one-month interval between the data theft and the ransom demand.

• Royal Ransomware. The group, which has been one of the most active ransomware organizations attacking the healthcare industry, claimed responsibility for a cybersecurity incident affecting Morris, Illinois Hospital & Healthcare Centers on May 25. Royal Ransomware has clearly been a royal pain in the behind. Writers for SC Media point out that the criminal operation has been leveraging the newly emergent BlackSuit ransomware encryptor in limited attacks amid ongoing intrusions against enterprises.
  
  It may be remembered that it was another Illinois-based hospital that was crippled by a cybersecurity onslaught just two years ago. St. Margaret’s Health in Spring Valley, Illinois, is scheduled to permanently close its doors on June 16 of this year. The facility is believed to be the first hospital in the United States to close because of a ransomware attack. The facility has simply been unable to recover from the 2021 hack attack that hampered the hospital’s ability to submit claims to payers for several months.

• BianLian Ransomware. Healthcare is one of the most targeted industries for this group, which, like other ransomware-based groups, seeks to obtain a financial advantage at the expense of its victims. On May 16th, the U.S. Federal Bureau of Investigation (FBI), as well as CISA, released an advisory identifying certain tactics and techniques that indicated illicit activity being undertaken by the BianLian ransomware group.

Mitigating the Risks

We have seen how devastating some of these cyberattacks have been, causing at least one hospital to shut down permanently. This, alone, points to the absolute priority of bolstering your facility’s defenses against the never-ending assaults on your ability to operate. It will be imperative for your chief information officer, as well as others in charge of data security, to keep abreast of the latest threats, such as those listed above. One of the best ways to do this would be to monitor the leading websites that keep track of such threats. In addition, regular monitoring of the CISA website is strongly recommended. The site not only informs the consumer of the current threats but also offers valuable guidance on how to better prepare your defenses against these onslaughts.

When it comes to securing your data and critical systems, hospitals will need to invest in the right resources to safeguard their castle wall. The enemy is coming. Hire the best. Do your best. The consequences of defeat are unthinkable.

from
https://www.coronishealth.com/blog/under-attack-hospitals-face-new-cybersecurity-threats/

Partnering with an Experienced Revenue Cycle Management Leader for Higher ROI

The Shift Toward RCM Partnerships in the Healthcare Industry

In today’s rapidly changing healthcare landscape, revenue cycle management (RCM) plays a pivotal role in maximizing return on investment (ROI) for healthcare providers. As per the latest research from the esteemed 2023 Black Book healthcare survey, the industry as a whole is increasingly turning toward third-party RCM as a strategic solution. 

At Coronis Health, we recognize the value of partnering with an experienced RCM organization and aim to dig deeper into why this trend is gaining traction and how we can forge collaborative partnerships that drive optimal revenue cycle management outcomes for our clients.

Revealing the Demand: Healthcare’s Call for RCM Optimization Is Clear

Black Book’s comprehensive survey on healthcare confirms that 17% of surveyed hospitals are leveraging advisors and consultants to synchronize their RCM transition activities. With the shift from volume-based to value-based care, selecting the right technology vendors becomes crucial for healthcare providers. 

Surprisingly, the survey reveals that 78% of healthcare providers have faced challenges in choosing appropriate vendors, leading to a surge in demand for experienced RCM providers.

Collaborating for Success

The survey further indicates that nearly three-quarters of medical group practices (73%) are collaborating with consultants to develop accountable care reimbursement strategies. The demand for outsourcing services in revenue cycle management stems from the healthcare industry’s pressing need to:

• Optimize ROI
• Reduce overhead costs
• Streamline internal processes
• Enhance overall efficiency

Unlocking the CFO Perspective: Working with a Leading RCM Company for Increased ROI

Coronis Health understands the importance of RCM from a CFO’s perspective. According to Black Book, an alarming 79% of health organization CFOs highlight the urgent need to eliminate financial and coding technology vendors that fail to deliver ROI revenue cycle management advantages. 

• Over half of the health organization CFOs (54%) affirm that outsourcing RCM processes can significantly boost productivity and ensure a robust financial foundation.

Modernizing RCM Systems for Success

In the healthcare industry, there is a pressing need for an upgrade in RCM systems. Black Book’s previous report reveals that a staggering 89% of healthcare providers are well aware of this requirement. 

• Outdated nineteenth-century tools, like manual record-keeping, and the utilization of modern twenty-first-century technology creates complexity and hampers the advancement of medicine.

Seizing New Opportunities by Forming a Strategic RCM Alliance

As improper RCM management starts affecting cash flow, claims management becomes the next area where vendors can seize opportunities, followed by eligibility and benefits management. Black Book reports that 83% of hospitals, 58% of contract management, and 55% of denial management currently outsource some accounts receivable and collections. 

Partnering with a leader in RCM empowers healthcare providers to reduce costs, improve efficiency, and optimize their revenue cycle management processes, ultimately enabling them to prioritize delivering high-quality patient care.

Taking Action for Financial Success

Crucial findings from the Black Book healthcare survey provide valuable insights for CFOs. A significant finding reveals that 50% of US hospitals, despite anticipating the replacement of their core RCM solution, have failed to initiate a sustainable RCM plan. However, more than 1,000 hospitals have already implemented new or renegotiated hospital revenue cycle services, emphasizing the need for swift and effective action to adapt to the evolving healthcare landscape.

Overcoming Challenges for Small Hospitals 

The survey further identifies a concerning trend: 40% of hospitals with fewer than 200 beds are delaying the implementation of a functional RCM transformation program. This delay poses potential financial difficulties and compromises patient care, as smaller hospitals may lack the necessary resources and expertise to manage RCM effectively.

Leveraging an Experienced RCM Company As the Key to Success

The healthcare industry is facing unprecedented challenges, and partnering with a leading RCM company may be the key to saving it. 

With decades of experience in healthcare-focused RCM serving nine unique specialties, Coronis Health has the necessary tools to help hospitals healthcare facilities of all sizes thrive in a dynamic landscape. 

Our ability to address acute and long-term needs is unmatched. Whether your facility needs coding support or end-to-end RCM, Coronis Health has the ability to scale and anticipate your changing needs.

Schedule a complimentary financial health checkup today to close holes in your revenue cycle. We find missing revenue in 95% of our financial assessments and can provide actionable solutions to optimize your RCM processes.

from
https://www.coronishealth.com/blog/partnering-with-an-experienced-revenue-cycle-management-leader-for-higher-roi/

End of the Injection Mandate: Ramifications for Hospitals

It is safe to assume that most people do not have a positive impression of the word “mandate.” The very concept is anathema to the average American as it runs counter to our revolutionary spirit and the sensibilities of our founding document. We assert that we are a free people, living in “the land of the free,” and so to be told that we are under some sort of mandate is akin to feeling forced against our will. There is something visceral in our reaction to the word.

Back in 2021, researchers at Harvard Business School seemed to agree with the above sentiment, writing the following:

Mandates feel like a violation of autonomy, which is one of the five most important intrinsic drivers of threat and reward in the brain. Autonomy is a feeling of being in control and having a choice. When we have choices, we experience natural rewards of feeling positive. Research shows that even affording a little autonomy can go a long way: When employees at one company were given the opportunity to choose how to decorate their workspaces, their productivity increased up to 25 percent. On the flip side, when we perceive choices being taken away, we feel stronger reactions of frustration all the way to anger, which can significantly diminish our ability to focus, not to mention collaborate.

It is, therefore, no wonder that a certain segment of the population recoiled back in 2020 upon being told that they were under a federal mandate to submit to a certain medical procedure or risk losing their livelihood.

A Sore Spot

There is no doubt that one of the major contributors to the ongoing nurse shortage crisis being felt by many U.S. hospitals is the federal mandate, issued under the Biden Administration, that requires all healthcare workers within facilities that participate with Medicare or Medicaid—which accounts for nearly every acute care hospital in the country—to be injected with substances that include controversial mRNA technology. Lawsuits from concerned workers who felt the mandate violated their personal rights, beliefs, conscience, science, etc., reached the U.S. Supreme Court. However, in a 5-to-4 decision last year, the federal mandate was upheld. The impact of this decision, no doubt, caused perhaps thousands of nurses to leave the profession.

Last July, the American Bar Association (ABA) wrote an article in which they cited a survey conducted by the American Nurses Association (ANA) in late 2021. The ANA represents 4.2 million nurses, and the survey of their membership revealed the following:

• Though 81 percent said they were comfortable getting the vaccine, only 59 percent said they supported the vaccine mandate.
• Two-thirds (66 percent) said that Food and Drug Administration (FDA) approval of the vaccines would not change their minds.
• 58 percent were not certain of the vaccine’s immunity and effectiveness.
• 84 percent of those not vaccinated declined because they essentially questioned the safety of the injection.

While we may never know how many nurses left their hospital positions solely due to the injection mandate, their departure certainly contributed to a lack of available nurses in many of America’s first-line facilities. The good news is that the underlying cause of their resignations or terminations looks to be going away.

Lifting of the Mandate

The Washington Examiner, in addition to other news outlets, is reporting that the Biden Administration is lifting the COVID injection requirements two years after enacting them. The mandate, which affected some 10.4 million workers in the U.S., will end later this summer. The White House published an official statement on May 1 ordering the end of COVID-related injection mandates for federal workers, effective May 11—the last day of the public health emergency (PHE). That same release stated that rules would later be promulgated detailing the date and circumstances for the ending of the mandate related to health workers in Medicare and Medicaid facilities. Those rules have now been made available.

On May 31, the Centers for Medicare and Medicaid Services (CMS) issued a pre-published version of its 82-page final rule, which sets forth the timeline for the ending of the injection mandate. The final rule was officially published in the Federal Register on June 5. The rule would go into effect 60 days later. The rule states that the government would continue to rely on data reporting to monitor the virus’ evolution and effect on residents and staff.

The American Hospital Association (AHA) released the following analysis of the final rule:

The rule withdrew the COVID-19 health care staff vaccination requirements including removing the requirement for COVID-19 vaccination policies and procedures for health care staff. CMS’ quality measures assessing the proportion of health care workers who are vaccinated for COVID-19 remain in place.

The question now becomes: how will the lifting of the mandate impact the nurse shortage currently affecting many of our nation’s hospitals? Will a significant percentage of nurses who left their positions due to the mandate consider returning to duty this August? If so, hospitals may find themselves in better shape from a staffing perspective in the months ahead.

from
https://www.coronishealth.com/blog/end-of-the-injection-mandate-ramifications-for-hospitals/

2024 IPPS Proposed Rule: Incentive Programs

Over the last two weeks, we have brought you highlights from the 2024 Inpatient Prospective Payment System (IPPS) Proposed Rule (PR) published last month by the Centers for Medicare and Medicaid Services (CMS). Today’s article will focus on the incentive programs applicable to hospital inpatient services that are being proposed for the 2024 fiscal year (FY).

Hospital Inpatient Quality Reporting Program

The Hospital Inpatient Quality Reporting (IQR) Program involves a pay-for-reporting concept relative to Medicare cases in the inpatient setting. Hospitals that do not submit quality measure data or fail to meet all Hospital IQR Program requirements are subject to a one-fourth reduction in their Annual Payment Update (APU) under the IPPS.

In the 2024 PR, CMS is proposing to adopt three new quality measures, remove three existing quality measures, and modify three current quality measures. Two changes to current policies related to data submission, reporting, and validation are also being proposed. Here are the specifics:

New Measures

• Hospital Harm — Pressure Injury eCQM, with inclusion in the eCQM measure set beginning with the CY 2025 reporting period/FY 2027 payment determination.
• Hospital Harm — Acute Kidney Injury eCQM, with inclusion in the eCQM measure set beginning with the CY 2025 reporting period/FY 2027 payment determination.
• Excessive Radiation Dose or Inadequate Image Quality for Diagnostic Computed Tomography (CT) in Adults (Hospital Level — Inpatient) eCQM, with inclusion in the eCQM measure set beginning with the CY 2025 reporting period/FY 2027 payment determination.

Modified Measures

• Hybrid hospital-wide all-cause risk standardized mortality measure beginning with the FY 2027 payment determination. CMS is proposing to modify this measure to include Medicare Advantage (MA) admissions.
• Hybrid hospital-wide all-cause readmission measure beginning with the FY 2027 payment determination. CMS is proposing to modify this measure to include MA admissions.
• COVID-19 Vaccination among Healthcare Personnel (HCP) measure, beginning with the Quarter 4 CY 2023 reporting period/FY 2025 payment determination. The proposed measure update would report the cumulative number of HCP who are up to date with recommended COVID-19 vaccinations.

Deleted Measures

• Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty and/or total knee arthroplasty measure beginning with the FY 2030 payment determination.
• Medicare spending per beneficiary (MSPB) hospital measure beginning with the FY 2028 payment determination.
• Elective delivery prior to 39 completed weeks’ gestation: Percentage of babies electively delivered prior to 39 completed weeks’ gestation measure (also known as PC-01) beginning with the CY 2024 reporting period/FY 2026 payment determination.

Medicare Promoting Interoperability Program

The 2024 PR contains the following changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs):

• Modify requirements for the Safety Assurance Factors for EHR Resilience (SAFER) Guides measure to require eligible hospitals and CAHs to attest “yes” to having conducted an annual self-assessment of all nine SAFER Guides at any point during the calendar year in which the EHR reporting period occurs, beginning with the EHR reporting period in CY 2024, in order to satisfy the definition of a meaningful EHR user under 42 CFR 495.4.
• Amend the definition of “EHR reporting period for a payment adjustment year” for participating eligible hospitals and CAHs to define the EHR reporting period in CY 2025 as a minimum of any continuous 180-day period within CY 2025.
• Amend the definition of “EHR reporting period for a payment adjustment year,” for eligible hospitals that have not successfully demonstrated meaningful EHR use in a prior year, to remove the requirement to attest to meaningful use by October 1st of the year prior to the payment adjustment year, beginning with the EHR reporting period in CY 2025.    
• Modify the response options related to unique patients or actions, for objectives and measures for the Medicare Promoting Interoperability Program, for which there is no numerator and denominator, and for which unique patients or actions are not counted. The response option would read “N/A (measure is Yes/No).”
• Adopt three new eCQMs for eligible hospitals and CAHs to select as one of their three self-selected eCQMs, in alignment with the Hospital IQR Program, beginning with the CY 2025 reporting period:
  • Hospital Harm — Pressure Injury eCQM;
  • Hospital Harm — Acute Kidney Injury eCQM; and
  • Excessive Radiation Dose or Inadequate Image Quality for Diagnostic CT in Adults (Hospital Level — Inpatient) eCQM.

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

The PCHQR Program is a quality reporting program for the eleven cancer hospitals that are statutorily exempt from the IPPS. CMS collects and publishes data from PCHs on applicable quality measures. In the FY 2024 IPPS/LTCH PPS proposed rule, CMS is proposing the following:

• Begin public display of the Surgical Treatment Complications for Localized Prostate Cancer measure beginning with data from the FY 2025 program year.
• Adopt four new measures for the PCHQR Program:
  • Facility Commitment to Health Equity beginning with the FY 2026 program year.
  • Screening for Social Drivers of Health beginning with voluntary reporting in the FY 2026 program year and mandatory reporting in the FY 2027 program year.
  • Screen Positive Rate for Social Drivers of Health beginning with voluntary reporting in the FY 2026 program year and mandatory reporting in the FY 2027 program year.
  • Documentation of Goals of Care Discussions Among Cancer Patients beginning with the FY 2026 program year.
• Modify the COVID-19 Vaccination among HCP measure, in alignment with the Hospital IQR Program and LTCH QRP.
• Modify the data submission and reporting requirements for the HCAHPS survey measure, beginning with the FY 2027 program year.

Again, if you wish to see the fact sheet published by CMS that summarizes the 2024 IPPS PR, please go to FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule – CMS-1785-P | CMS.

from
https://www.coronishealth.com/blog/2024-ipps-proposed-ruleincentive-programs/