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Insights and Trends

Headlines from the Hill: September Edition

Stay ahead of the latest regulatory shifts and healthcare breaking news with Headlines from the Hill.

In this month’s edition you will find:

Inpatient Rehab Provider Preview Reports: Review required by mid-October.

The Inpatient Rehabilitation Facility (IRF) Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on Care Compare and Provider Data Catalog (PDC) during the December 2023 refresh.

The data contained within the Preview Reports are based on quality assessment data submitted by IRFs from Q2, 2022 through Q1, 2023. The data for the claims-based measures will display data from Q4, 2020 through Q3, 2022 for this refresh. Providers have until October 16 to review their performance data.

Only updates/corrections to the underlying assessment data before the final data submission deadline will be reflected in the publicly reported data on Care Compare. If a provider updates assessment data after the final data submission deadline, the updated data will only be reflected in the Facility-Level Quality Measure (QM) report and Patient-Level QM report.

Updates submitted after the final data submission deadline will not be reflected in the Provider Preview Reports or on the Care Compare website. However, providers can request CMS review of their data during the preview period if they believe the quality measure scores that are displayed within their Preview Reports are inaccurate.

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Physician Fee Schedule Proposed Rule: New comments sent to CMS.

The Federation of American Hospitals (FAH) – with input from Lifepoint – filed comments regarding the CY 2024 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies proposed rule. Key FAH comments include:

    • Support proposals that would extend through the end of December 31, 2024, multiple Medicare telehealth flexibilities as well as defining direct supervision to permit the presence and “immediate availability” of the supervising practitioner through real-time audio and visual interactive telecommunications.

    • Urge CMS to actively monitor use of the Office/Outpatient E/M visit complexity add-on code G2211 and undertake any needed mid-course corrections to ensure appropriate usage of the code.

    • For purposes of a split (or shared) Medicare payment to a physician and non-physician practitioner, support delaying the definition of a “substantive portion” of a shared visit (as more than half of the total time) through at least December 31, 2024, and urge this delay to be permanent.

    • Support pausing implementation of the appropriate use criteria program for advanced diagnostic imaging services.

    • Oppose multiple proposals regarding the Medicare provider enrollment regulations that create undue burdens or unintended consequences, for example: expand reasons to revoke or deny Medicare enrollment; implement a new stay of Medicare enrollment status; shorten the time for reporting a change, addition, or deletion of a practice location for hospitals; and shorten the timeframe within which a provider may obtain a reversal of a Medicare revocation.

    • Urge CMS to support and work with Congress to avert the 1.25% physician fee schedule payment reduction for CY 2024. 

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Rising Readmissions Penalties: More hospitals expected to be charged.

Preliminary CMS data released states more hospitals will face readmission penalties in 2024 – most likely due to hardships hospitals experienced during peak pandemic months.

For the upcoming year, 70.1% of hospitals will be charged penalties of less than 1% on their readmissions compared with 67.1% of hospitals in fiscal 2023. The official data is expected to be released in October.

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CMS Updates Inpatient Rehab Quality ‎Reporting Program Annual Increase Factor Table. ‎

On September 12, CMS published an update to the inpatient rehabilitation facility (IRF) Quality ‎Reporting Program (QRP) Annual Increase Factor (AIF) table for reporting assessment-based quality ‎measures (QMs) and standardized patient assessment data elements affecting FY 2025 and FY 2026 AIF ‎determination.

The changes to the tables reflect the data elements that will be required to meet the AIF ‎minimum data completion threshold for FY 2025 and FY 2026 respectively. Among these measures is ‎the up-to-date patient COVID-19 vaccination measure beginning with the FY 2026 IRF QRP.

Additionally, ‎the goal items found in the FY 2025 AIF table are dropped from the FY 2026 AIF table.

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Medicare Advantage Benefits: MedPAC considering standardizing benefits. ‎

The Medicare Payment Advisory Commission (MedPAC) sketched out options for standardizing benefits in the Medicare Advantage (MA) program to make it easier for seniors to choose coverage. MedPAC said its goal would be to enhance the competition that is at the heart of the program without unduly restricting innovation by plans or affecting beneficiaries with special needs.

What you should know:

    • MedPAC is considering whether benefits should be standardized in Medicare Advantage amid proliferation of MA plans and benefit packages that seniors report they find confusing.

    • Commissioners appeared to coalesce around standardization only for conventional MA plans and for Parts A & B and dental/hearing/vision benefits.

    • The proposed approach would preserve variation in other supplemental benefits and likely would be phased in over several years to minimize disruption in the MA program.

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