The Trump administration is proposing to rewrite rules on federal payments to hospitals treating older Americans on Medicare, making it easier for patients to see the prices of procedures and care.
While some prices are now available for consumers to view upon request, the new standard would require providers to post them, which would then make it easier for insurers and other processors to analyze them.
Specifically, CMS is aiming to reduce regulatory burdens on clinicians and hospitals, but the agency is also proposing that they equip themselves, technologically and policy-wise, to grant patients access to their data in EHRs and post pricing for care services in a way consumers can understand.
The 2015 edition could help patients collect their health data from multiple providers using application programming interfaces (APIs), perhaps bringing all their health data together into a single digital place, the agency said.
The proposed rule also eliminates a number of redundant reporting measures that are a part of the IPPS and PPS programs.
In fiscal year 2017, CMS estimated that federal spending on the program would total more than $709 billion, with 58 million individuals receiving insurance.
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"We are removing measures that are topped-out - meaning the overwhelming majority of providers are performing well on them - duplicative measures, and measures that are excessively burdensome to report", stated Verma. As such, it changed the name of the EHR incentive program to "Promoting Interoperability", and proposed to update scoring methodology and add new measures, including one to address e-prescribing of opioids.
It would eliminate a significant number of criteria acute care hospitals are now required to report and it would remove duplicative measures across the five-hospital quality and value-based purchasing programs.
The proposed rule would implement a 90-day EHR reporting period for providers participating in the EHR Incentive Programs in 2019 and 2020. "Secretary Azar has made such a value-based transformation in our healthcare system a top priority for HHS, and CMS is taking important, concrete steps toward achieving it".
Ultimately, all of these efforts aim to improve healthcare for the patient, said CMS Administrator Seema Verma. When incorporating other changes in the rule and updates to uncompensated care, capital and low-volume hospital payments, the total IPPS increase is 3.4 percent. Those that do not would be at risk of penalties in their Medicare payments starting two years later, according to a CMS official who spoke to reporters on the condition of anonymity. With a May 25, 2018 deadline, CMS is also seeking input on the direct provider contracting between payers and primary care or multi-specialty groups for a potential test of a direct provider contracting within Medicare, Medicare Advantage and Medicaid.