Maternal Health, Equity Key Factors in Proposed CMS Rule for Hospitals

In a new proposed payment rule for inpatient and long-term hospitals, CMS suggested the establishment of a “birthing-friendly” hospital designation in an effort to promote better health outcomes among mothers.

In addition to addressing the nation’s maternal health crisis, the proposed rule includes three equity-focused measures as a way to improve care among underserved and disadvantaged patients. The rule also aims to promote Medicare payment accuracy and hospital stability.

Maternal Health

According to a CMS fact sheet, any hospital that can attest to “participating in a structured state or national Perinatal Quality Improvement (QI) Collaborative” or “implementing patient safety practices or bundles as part of these QI initiatives” will be granted the “birthing-friendly” designation, which will be publicly reported on CMS’ Care Compare website.

The goal of these QI initiatives is to encourage hospitals to follow best practices in maternity care and to allow CMS to leverage data that’s already being collected for the Hospital Inpatient Quality Reporting Program, thereby avoiding duplicative data collection and administrative burden for hospitals.

Other measures will be added over time and a “more robust scoring methodology for the designation” is expected to be developed through future notice-and-comment rulemaking, according to the fact sheet.

“Ultimately, CMS’ goal is not simply to grant hospitals a maternal health ‘gold star,’ but to do so in a way that is meaningful for patients and families in search of facilities with a demonstrated commitment to the delivery of high-quality, safe, and equitable maternity care,” the fact sheet stated.

The agency is also requesting input on strategies for advancing equity and reducing disparities in maternal care.

Initial results for the hospital designation will be released in Fall 2023.

Health Equity, Hospital Stability

To reduce healthcare disparities, CMS said it is aiming to gauge hospitals’ commitment to building a culture of health equity by evaluating their efforts in five areas: strategic planning, data collection, data analysis, quality improvement, and leader participation.

CMS also plans to promote screening for and identifying patients’ social needs, including food insecurity, housing instability, personal safety, transportation, and trouble meeting utility bills.

“By screening for and identifying such unmet needs, 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 agency noted in a press release.

CMS is also requesting feedback on ways to “optimally measure health care quality disparities,” as well as stakeholder input through a request for information on social determinants of health, especially homelessness, reported in Medicare claims.

“Consistently documenting these factors could better support people experiencing homelessness and more fully consider resources expended by hospitals,” the agency said.

Other provisions in the proposed rule focus on payment stability for hospitals, including “a policy that smooths out significant year-to-year changes in hospitals’ wage indexes and a solicitation for comments on payment adjustments for purchasing domestically made surgical N95 respirators,” they noted.

The agency also said that acute care hospitals paid in the Inpatient Prospective Payment System that “successfully participate” in the Hospital Inpatient Quality Reporting Program and appropriately use electronic health records can expect a proposed increase of 3.2% in operating payment rates, subject to adjustments including reductions for excess readmissions and hospital-acquired infection rates.

In addition, CMS anticipates payments under the Long-Term Care Hospital Prospective Payment System to increase by approximately 0.8%, or $25 million. The agency estimates that Medicare Disproportionate Share Hospital (DSH) and uncompensated care payments will decline by approximately $800 million.

Stakeholders React

Stacey Hughes, executive vice president, government relations and public policy, for the American Hospital Association, said she was disappointed with these projections.

“We are extremely concerned with CMS’ proposed payment update of only 3.2%, given the extraordinary inflationary environment and continued labor and supply cost pressures hospitals and health systems face. Even worse, hospitals would actually see a net decrease in payments from 2022 to 2023 under this proposal because of proposed cuts to DSH and other payments,” she said in a press release.

“This is simply unacceptable for hospitals and health systems, and their caregivers, that have been on the front lines of the COVID-19 pandemic for over 2 years now. While we have made great progress in the fight against this virus, our members continue to face a range of challenges that threaten their ability to continue caring for patients and provide essential services for their communities,” she added.

Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals, said his organization was pleased with the proposed rule’s “extensive focus on improving health care equity and reducing health disparities.” However, he warned that “meaningful change will require partners and policies outside our hospitals’ circle — housing, education, social services, and other stakeholders, who touch upstream factors that influence health.”

“It also will require a sound foundation of evidence, including sociodemographic data, to understand the challenges historically disadvantaged patients face. We must build that foundation first and carefully develop and evaluate meaningful measures linked to outcomes. This is especially important, as hospitals are in varying places on the journey to health equity. We welcome tools and other resources from CMS to help hospitals continue this crucial work,” he continued.

Siegel also expressed his disappointment over DSH payments showing a decline for the third year in a row. “This would undermine vital support for essential hospitals as they recover from the financial stress of the COVID-19 public health emergency, which continues.”