New Regulations Include Four Final Rules

Four final payment rules dominate CMS week of activity.

In the world of healthcare regulation, when it rains, it pours – but then occasionally, like last week, we get a drought.

Last week, the Centers for Medicare & Medicaid Services (CMS) started the release of the 2022 final rules, for inpatient psychiatry, inpatient rehabilitation facilities (IRFs), hospice, and skilled nursing facilities (SNFs). And I can sum them up by saying for the majority of our audience, these four rules could not be more boring.

As always, they announced the final payment rates, and the finance people get all excited over a tenth of a percent, one way or the other. Now, I know that a tenth of a percent adds up quickly to millions of dollars, but it doesn’t change the daily work we all do one bit. I’ll give you an idea of how unexciting these final rules are: the most exciting part was that CMS removed certain wheelchairs and cushions from the competitive bidding process. Yep, people were actually tweeting with excitement over this.

On the other hand, of course, conversation and uncertainty continues over the reversal by CMS on the Inpatient-Only List and Ambulatory Surgery Center (ASC) allowed list. I keep reading the CMS commentary, and each time I discover something new. For example, we know that CMS has already designated nine surgeries, including total hip arthroplasty, to be continued to be allowed at ASCs. But that list did not include placement of a cardiac drug eluting stent. You may recall that two years ago, CMS started to allow stenting at ASCs, but first only allowed bare metal stents and then expanded the list this year.

I am sure that all the ASCs that have started doing elective cardiac interventions with the drug-eluting stents, which are preferred in most circumstances, are not happy about that. In fact, CMS is asking commenters to suggest to them procedures that can continue to be performed at ASCs (and asking for data demonstrating that it is safe), and you can bet that these ASCs will ask to be allowed to continue, as they should. But at the same time, CMS admits that the number of requests may exceed their capacity to review, so they are also soliciting suggestions on how they should prioritize the requests. I wonder how many cardiologists will suggest that their request to get drug-eluting stents kept in the ASC-allowed list be given a lower priority than a request by orthopedists for their procedures.  

Finally, I want to leave you with an image that will be stuck with you all day. Every year, companies petition CMS for pass-through payment status for their new technologies. This year, a company is asking for pass-through status for their product, the Pure-Vu system. What does this product do? It is used during colonoscopies, and “uses a unique High Intensity, Pulsed Vortex Irrigation Jet that consists of a mixture of air and water to break-up fecal matter, blood clots, and other debris, and scrub the walls of the colon while simultaneously removing the debris through two suction channels.” If you want to get that image out of your head, I would suggest humming a few bars of “Who Let the Dogs Out,” and that will promptly get stuck instead.

Programming Note: Listen to Dr. Ronald Hirsch when he makes his Monday Rounds, Monday on Monitor Mondays, 10 Eastern, and sponsored by R1RCM.


Ronald Hirsch, MD, FACP, CHCQM, CHRI

Ronald Hirsch, MD, is vice president of the Regulations and Education Group at R1 Physician Advisory Services. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians. Dr. Hirsch is a member of the RACmonitor editorial board and is regular panelist on Monitor Mondays. The opinions expressed are those of the author and do not necessarily reflect the views, policies, or opinions of R1 RCM, Inc. or R1 Physician Advisory Services (R1 PAS).

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