On April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) announced proposed policy rule changes to further their stated goal of promoting a patient-centered healthcare system through increased hospital price transparency, and increased interoperability through improved use of electronic health records (EHRs). Changes will affect the 2019 Medicare Inpatient Prospective Payment System (IPPS) and the Long Term Acute Care Hospital (LTCH) Prospective Payment System.
With regard to hospital price transparency, CMS wants to amend its interpretation of existing law, which mandates that hospitals allow the public to see standard charges, to require hospitals to make these standard charges publicly available on the Internet. CMS is also seeking comments about out-of-network “surprise” billing and facility/physician fees for emergency room visits. In addition, the agency is considering making information about non-compliant facilities publicly available.
The Medicare and Medicaid Electronic Health Record Incentive Programs, now known informally as the “Meaningful Use” program, will be renamed “Promoting Interoperability”. CMS says that the proposed rule will decrease the number of measures that acute care hospitals will be required to report, although 21 of the “eliminated” measures were merely characterized as duplicative with other government reporting requirements that may still exist. Another 18 measures were considered to be no longer relevant or had data collection difficulties/cost considerations that outweighed the measure’s perceived benefit, and would be removed.
CMS also wants to make it easier for patients to obtain their electronic medical records by incentivizing providers to facilitate data sharing through application programming interfaces (APIs).
In addition, CMS is asking for public comment on chimeric antigen receptor (CAR-T) cell therapies, in particular "the pending Kymriah (Novartis) and Yescarta (Kite Pharma) technology add-on payment applications, and the most appropriate way to establish payment for FY [fiscal year] 2019 under any alternative approaches."
It will be easier to assess the implications once a final rule is published. However, in terms of pricing transparency, it does indicate that CMS intends to use market forces, aka “price shopping”, to help curb consumer spending on hospital services.
The proposal will be published in the U.S. Federal Register on May 7, 2018. A factsheet is available here, and a copy of the unpublished, proposed rule, CMS-1694-P, can be found here. Note that the deadline for submitting comments is June 25, 2018, but comments will not be accepted until the document is published in the Federal Register.