IHA Daily Briefing: Nov. 2

CMS Publishes CY 2019 Medicare OPPS/ASC Final Rule
AMA Announces Residency Transformation Grants
careLearning: e-Learning. Real-World Advantages.
Briefly Noted

CMS Publishes CY 2019 Medicare OPPS/ASC Final Rule
Today, the Centers for Medicare & Medicaid Services (CMS) published a display version of its final rule with comment period addressing changes in Medicare payments for the hospital outpatient prospective payment system (OPPS) and ambulatory surgery center (ASC) services for the calendar year (CY) 2019. The rule, which is scheduled for publication in the Federal Register on Nov. 21, is effective for services provided on or after Jan. 1, 2019.

Highlights of the final rule include:

  • An estimated increase in OPPS rates of 1.35 percent, when compared to final CY 2018 rates. That percentage is comprised of: a market basket increase of 2.9 percent, reduced by Affordable Care Act (ACA) legislative reductions of 0.75 percent and 0.8 percent for productivity. However, this increase will be significantly offset by the payment reduction resulting from the expansion of the site-neutral policy to include visits provided at off-campus clinics (see below);
  • CMS’ expansion of its site-neutral payment policy to include clinic visits made at off-campus, hospital-based outpatient departments. CMS will pay for those visits based on an “equivalent payment rate” determined using the Medicare Physician Fee Schedule (PFS). Currently those visits are paid the OPPS rate; however, in a change from the proposed rule, CMS will phase-in this payment change over a two-year period (2019/2020), versus full implementation in CY 2019;
  • CMS did not finalize its proposal that payments for 19 new “clinical families of services,” provided in “excepted” off-campus hospital departments, be based on the Medicare PFS. Those services will continue to be paid under the OPPS in CY 2019 but CMS has indicated that it will monitor the expansion and volumes of these services;
  • CMS’ expansion of CY 2018 340B payment reductions to include 340B-acquired drugs provided in “non-excepted” off-campus hospital departments, as proposed;
  • A continuation of the single payment rate for hospital-based partial hospitalization services. The final 2019 per diem rate for three or more services provided is $222.76, an increase of approximately 7 percent over the final CY 2018 rate of $208.23. Additionally, CMS is soliciting comments on the deletion of six existing codes for hospital-based, partial hospitalization programs, replacing them with nine new codes in CY 2020. Those comments are due to CMS no later than Dec. 3.;
  • An estimated increase in the ASC rates of 2.1 percent, when compared to final CY 2018 rates. That percentage is comprised of: a market basket increase of 2.9 percent, reduced by an ACA productivity reduction of 0.8 percent;
  • ASC proposals including: expanding the number of procedures that can be safely performed in that setting; ensuring the payment for procedures involving high-cost devices parallels the amount paid to hospitals; and stabilizing the payment differences between ASCs and hospital outpatient departments;
  • Changes in the number of measures reported under both the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program;
  • Updating the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey to remove three pain communication questions; and
  • Other recommendations from the President’s Commission on Combatting Drug Addiction and the Opioid Crisis.

A CMS fact sheet contains further explanations of the major provisions of the rule. In the coming weeks, IHA will be sending out hospital-specific estimates on the impact of the rule, along with a more detailed rule summary.


AMA Announces Residency Transformation Grants
The American Medical Association (AMA) announced its Reimagining Residency program, a $15 million grant program to support innovative projects that promote systemic change. The AMA says that the grant will support innovations that:

  • Provide a meaningful and safe transition from undergraduate medical education to graduate medical education;
  • Establish new curricular content and experiences to enhance readiness for practice; and
  • Promote well-being in training.

Request for proposals will be distributed Jan. 3.  An informational webinar on the funding opportunity will take place on Jan. 16 from 11 a.m. – 12 p.m.


careLearning: e-Learning. Real-World Advantages.
careLearning is an online education company designed to help healthcare organizations by providing reliable, trusted, and easily-accessible talent management solutions. With careLearning, organizations can gain access to the Learning Management System (LMS), Competency and Performance Management Solution, a full course catalog, and much more.

The careSkills Competency Management System comes populated with skills required for successful performance by clinical and non-clinical employees and they are easy to customize. Once organizations have defined what is expected, the system can be used to create automated assessments. This makes it easy to collect and track employee competence and eliminate misplaced documents. The best part is at the end of this process, meaningful real-time data reports will be available to help:

  • Hire and retain the right employees;
  • Plan education curriculum with more precision;
  • Help employees develop their careers with focused attention; and
  • Effectively manage succession planning, low-volume and high risk skills, clinical ladders.

The careSkills Performance Management System assists organizations in each step of the performance appraisal process from setting goals to feedback and review so that the appraisal reflects what happens throughout an entire year.

For questions or more information, contact Abby Radcliffe.


Briefly Noted
Yesterday, U.S. District Judge James Boasberg ruled in favor of AHA and member hospital plaintiffs, ordering the Dept. of Health and Human Services (HHS) to reduce the backlog of Medicare appeals at the Administrative Law Judge level. HHS currently projects a 2018 Medicare appeals backlog of more than 426,000. According to the ruling, HHS is required to achieve: a 19 percent reduction by the end of fiscal year (FY) 2019; a 49 percent reduction by the end of FY 2020; a 75 percent reduction by the end of FY 2021; and elimination of the backlog by the end of FY 2022. HHS was also ordered to file quarterly status reports, starting Dec. 31.

Kaiser Family Foundation has updated its Health Insurance Marketplace calculator for open enrollment for the 2019 plan year which began Nov. 1. The calculator allows users to get an estimate of their health insurance premiums and what financial help may be available for marketplace plans sold in their local area. The calculator also helps consumers determine whether they could be eligible for Medicaid. A Spanish-language version of the calculator is also available.

The U.S. Bureau of Labor Statistics released its October employment report showing 250,000 jobs added for the month, with unemployment at 3.7 percent. Hospital employment increased by 13,000 last month, with healthcare adding a total of 36,000 jobs. Over the past 12 months, healthcare employment grew by 323,000.

The Food and Drug Administration issued a press release discussing its meetings with e-cigarette manufacturers.