On May 12, the Centers for Medicare and Medicaid Services (CMS) released its Calendar Year (CY) Inpatient Prospective Payment System (IPPS) proposed rule. The proposed rule, which is published annually, details proposed updates to Medicare payment policies, and estimates that inpatient hospital services spending will increase by roughly $2 billion next fiscal year. The IPPS proposed rule also typically details new technology add-on payments (NTAPs) for novel drug and device products as well as issues related to new or existing Medicare Severity-Diagnosis Related Groups (MS-DRGs), which represent payment bundles for certain inpatient services. Of particular note in the proposed rule:
- A new provision that would require hospitals to report certain market-based payment rates on their Medicare cost report, which would potentially aid in developing updates to MS-DRG relative weights to more closely adhere to market-based forces;
- A discontinuance of the NTAP for the Sentinel Cerebral Protection System used to remove thrombus and debris while performing transcatheter aortic valve replacement (TAVR) procedures due to its eligibility expiration under the program; and,
- Issues related to assignment of MS-DRG classifications to left atrial appendage closure (LAAC) devices.
It should be noted that historically this rule, as with other annual payment rules for outpatient and physician payments, tend to conform to longstanding payment policies and may lag advances in medicine that make the practice of medical care more efficient. For instance, advances that may make certain procedures more efficient may result in a reduced overall payment for the procedure due to reduced length of stay and improved patient outcomes. For example, the CY 2019 IPPS rule reduced the weighted national payment average for transcatheter aortic valve replacement (TAVR) by 4.4 percent from the previous year due to associated efficiencies while increasing payment for open-heart surgical repair alternatives. Heart Valve Voice US will continue to advocate for changes to these annual payment rules that will increase the uptake of new heart valve and other cardiac procedures that benefit the wellbeing of the nation’s patients.
Comments to the proposed rule are due July 10 at 5 PM ET. A final rule is expected to be issued early this fall.