CMS Continuing Push for Health Equity With New Proposed Rule

The plan includes a goal to improve maternal health outcomes.

Federal officials currently engaged in a prolonged push to address health disparities across the U.S. are using an annually issued proposed rule as one way to make their case.

The Centers for Medicare & Medicaid Services (CMS) has issued the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule for the 2023 fiscal year, featuring measures that will “encourage hospitals to build health equity into their core functions, thereby improving care for people and communities who are disadvantaged and/or underserved by the healthcare system,” the agency said in a press release. The rule also includes three health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health (SDoH) in inpatient claims data, and proposes a new “birthing friendly” hospital designation.

For acute-care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users, the proposed increase in operating payment rates is projected to be 3.2 percent, officials noted.

“Building a healthier America starts with ensuring everyone in our nation has access to high-quality, affordable healthcare,” U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra said in a statement. “The new Medicare policies we are proposing today will help advance health equity in our health systems and dramatically improve maternal care for new parents and their newborns.”

“This rule, which funds a substantial portion of Medicare programs, is crucial to the foundation of CMS’s vision, ensuring access for all people with Medicare and maintaining incentives for our hospital partners to operate efficiently,” CMS Administrator Chiquita Brooks-LaSure added. “This year – through a health equity lens – we are also re-envisioning the next chapter of healthcare quality and patient safety.”

Officials defined health equity as “the attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.”

The three new measures speak to that goal. The first “assesses a hospital’s commitment to establishing a culture of equity and delivering more equitable healthcare by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement,” CMS said. The second and third measures “capture screening and identification of patient-level, health-related social needs, such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety.” By screening for and identifying such unmet needs, officials said hospitals will be in a better position to serve patients holistically – by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.

The announcement also featured several forms of solicitation of feedback; CMS noted that it is currently seeking public input on “how to optimally measure healthcare quality disparities, including what to prioritize in data collection and reporting, as well as approaches to consider in driving provider accountability across hospital quality programs.” The proposed rules also feature a Request for Information (RFI) on the SDoH, particularly related to homelessness, reported by hospitals on Medicare claims.

“Consistently documenting these factors could better support people experiencing homelessness and more fully consider resources expended by hospitals,” the agency’s press release read. “With this RFI, CMS seeks to better understand the perspectives of people who are experiencing or have experienced homelessness, advocates representing people experiencing homelessness, hospitals, and other key stakeholders for consideration in future payment policies.”

As for the new “birthing friendly” hospital designation, officials noted that Vice President Kamala Harris recently convened a first-of-its-kind White House meeting with Cabinet secretaries and agency leaders – including Becerra, Brooks-LaSure, and others – in order to discuss the “Administration’s whole-of-government approach to reducing maternal mortality and morbidity.”

At 5.8 deaths per 1,000 live births, the United States ranks No. 33 out of 36 Organization for Economic Cooperation and Development (OECD) countries (generally regarded as fully developed nations) in the metric.

“Improving maternal health outcomes – particularly among underserved communities and groups that we know experience adverse birth outcomes at a higher rate – is a top priority for the Biden-Harris Administration, CMS, and for me personally,” Brooks-LaSure said.

CMS said the “birthing friendly” hospital designation would assist consumers in choosing hospitals that have demonstrated a commitment to maternal health through implementation of best practices that advance healthcare quality, safety, and equity for pregnant and postpartum patients. Initially, the designation would be awarded to hospitals based on their attestation to the Hospital IQR Program’s Maternal Morbidity Structural Measure.

For a fact sheet on the proposed payment rule, click here.

For a fact sheet specific to the maternal health and health equity measures included in the proposed payment rule, click here.

The White House statement on Reducing Maternal Mortality and Morbidity, as part of the first-ever federal maternal health day of action, can be viewed online here.

The FY 2023 IPPS/LTCH PPS proposed rule has a 60-day comment period. The proposed rule can be downloaded in its entirety from the Federal Register here.