CMS Proposes Medicare Initiatives to Tackle Social Determinants of Health and Enhance Maternal Care

The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of proposed updates to the Medicare Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) for fiscal year 2025. These proposed changes aim to address social determinants of health (SDoH), improve emergency preparedness, and enhance access to quality maternal healthcare for Medicare beneficiaries across the United States.

Payment Rate Increases

Under the proposed rule, certain acute care hospitals are expected to receive a 2.6% increase in operating payment rates. This adjustment targets acute care facilities that meet specific criteria, including participation in the Hospital Inpatient Quality Reporting program and demonstrating meaningful use of electronic health records. CMS estimates that the proposed payment rate increases, combined with other changes, could result in a $3.2 billion increase in hospital payments.

Long-term care hospitals (LTCHs) may also benefit from a proposed 2.8% increase in the LTCH PPS standard federal payment rate, with LTCH payments potentially increasing by $41 million or 1.6%.

Addressing Social Determinants of Health

Recognizing the profound impact of SDoH on health outcomes, CMS proposes incorporating new SDoH data into LTCH quality reporting measures. These data elements include factors such as housing stability, food security, and transportation access, enabling healthcare providers to better understand resource needs and tailor care accordingly.

Moreover, CMS aims to build upon its efforts to support hospitals caring for homeless individuals by further increasing payments and exploring additional measures to address housing insecurity.

Improving Access to Innovative Treatments

In a move to expand access to essential treatments, particularly for rural and underserved communities, CMS proposes increased technology payments that could facilitate access to gene therapy for sickle cell disease, a condition that disproportionately affects underserved groups. Additionally, separate payments to small independent hospitals, including rural facilities, are being considered to ensure access to essential medications.

Enhancing Maternal Healthcare

CMS is actively seeking public feedback on potential solutions within hospital Conditions of Participation (CoPs) to address maternal morbidity, mortality, disparities, and accessibility to maternity care in the United States. This initiative aims to tackle the concerning disparities in maternal health outcomes, particularly for non-Hispanic Black women, American Indian and Alaska Native women, low-income women, and women with disabilities.

“Hospitals play such a central role in the diverse communities they serve,” said Meena Seshamani, MD, PhD, CMS deputy administrator and director of the Center for Medicare, in the release. “Our proposed payments to hospitals further recognize the cost of unmet social needs, advance access to innovative and essential treatments, expand the behavioral health workforce, and ultimately help provide hospitals the vital tools they need to better serve all communities.”

By addressing SDoH, improving emergency preparedness, and enhancing maternal healthcare access, CMS aims to promote health equity and ensure that Medicare beneficiaries receive high-quality, comprehensive care tailored to their unique needs.

Leveraging Health Note for Improved Care Delivery

As healthcare organizations navigate these proposed changes, Health Note can be a valuable tool to support their efforts in several ways:

  1. SDoH Insights: Health Note empowers providers to identify and document patients’ social needs, contributing to improved quality reporting and care coordination – a key focus of the proposed updates.
  2. Patient Engagement: By fostering active patient participation in their care journey, Health Note can lead to better outcomes and improved maternal health experiences. With Health Note, organizations capture 80% of patient data before a visit and up to 99% when tablets are additionally used in the office, ensuring comprehensive data collection and reducing bias.
  3. Data Analytics: With more complete and accurate data, healthcare organizations can leverage data analytics capabilities to track progress, identify areas for improvement, and demonstrate the impact of their efforts to CMS, aligning with the agency’s emphasis on quality reporting.

As the healthcare landscape continues to evolve, tools like Health Note can play a crucial role in helping providers adapt to regulatory changes while ensuring equitable access to quality care for all patients, including Medicare beneficiaries.

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"Our proposed payments to hospitals further recognize the cost of unmet social needs, advance access to innovative and essential treatments, expand the behavioral health workforce"