Proposed Rules Include Commitment to Better Care, Smarter Spending, and Healthier Medicare Beneficiaries as well as Implement the IMPACT Act

By: Patrick Conway and Sean Cavanaugh

In January, Secretary Burwell announced a new vision for the Medicare program, including clear goals and a timeline for shifting Medicare payments increasingly from volume to value.  Through this vision, we crystalized the work we have been pursuing across the agency into real, measurable goals.

Over the past few weeks, CMS began the annual process of updating the payment rates and policies that apply to providers who furnish care to Medicare fee-for-service beneficiaries. So far this month, we released proposed updates for hospital inpatient care, skilled nursing facilities, hospice providers, and a few others.

Through these updates, we’re proposing important updates that reflect how we want the Medicare program to help build a health care system that delivers better care, spends our health care dollars more wisely, and results in healthier people. For example:

  • Potentially Expanding Bundled Payments for Care Improvement – Through the CMS Innovation Center, CMS has been testing some promising new payment arrangements in an initiative called Bundled Payments for Care Improvement. In the proposed hospital inpatient prospective payment system (IPPS) rule, CMS is looking for public comment on issues we should consider if the initiative is expanded.
  • Updating the Hospital Value-Based Purchasing Program – At CMS, we’re always looking for opportunities to improve or sharpen our initiatives. CMS is proposing in the FY 2016 IPPS/LTCH proposed rule to expand the quality measures used in this program to assess hospital performance.
  • Introducing Value-Based Purchasing to Skilled Nursing Facilities – The proposed rule for Skilled Nursing Facility payments lays the groundwork for implementation of a new Value-Based Purchasing program, authorized by the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. 113–93), which will tie some portion of payments made to skilled nursing facilities to performance on a hospital readmission measure.

Implementation of the IMPACT Act

Several of the payment rules propose quality measurement requirements that implement the first stage of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Enacted on October 6, 2014, the IMPACT Act requires the Secretary to collect standardized patient assessment data and data on quality, resource use, and other measures from four types of post-acute care providers: home health agencies, inpatient rehabilitation facilities, skilled nursing facilities and long term care hospitals. The IMPACT Act also requires the reporting of quality measures and resource use measures in specific domains.

In the recently published rules, CMS has proposed to adopt the following cross-cutting quality measures for three of these four settings: (1) new or worsening pressure ulcers; (2) falls with major injury; and (3) having an admission and discharge functional assessment with a care plan that addresses function.

Seeking Comments

As with all work we do through rulemaking, we are looking for input from stakeholders and the rest of the public. We use those comments to make our final rules better, and make sure we’re on track.

The Secretary has put forward an exciting vision for the future of the Medicare program.  We’re looking forward to finding new ways to put the beneficiary experience first, and to make that vision a reality.


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