Medicare Promoting Interoperability Program
In 2011, CMS established the Medicare and Medicaid EHR Incentive Program (now known as the Medicare Promoting Interoperability) to encourage eligible professionals, eligible hospitals, and critical access hospitals (CAHs) to adopt, implement, upgrade, and demonstrate meaningful use of certified electronic health record (EHR) technology (CEHRT).
In the 2025 IPPS final rule, CMS is finalizing the following measures in the Medicare Promoting Interoperability Program for eligible hospitals and CAHs:
- Separation of the Antimicrobial Use and Resistance (AUR) Surveillance measure into two measures, Antimicrobial Use (AU) Surveillance and Antimicrobial Resistance (AR) Surveillance, beginning with the CY 2025 EHR reporting period; addition of a new exclusion for eligible hospitals or CAHs that lack discrete electronic access to data elements that are required for AU or AR Surveillance reporting; modification to the applicability of the existing exclusions to either the AU or AR Surveillance measures, respectively; and treatment of the AU and AR Surveillance measures as two new measures with respect to active engagement beginning with the CY 2025 EHR reporting period.
- Adoption of two new eCQMs for eligible hospitals and CAHs to select as one of their three self-selected eCQMs, in alignment with the Hospital IQR Program, beginning with the CY 2026 reporting period:
- Hospital Harm – Falls with Injury eCQM; and
- Hospital Harm – Postoperative Respiratory Failure eCQM.
- Modification of the Global Malnutrition Composite Score eCQM, beginning with the CY 2026 reporting period.
- Modification of eCQM data reporting and submission requirements in alignment with the Hospital IQR Program by finalizing a progressive increase in the number of mandatory eCQMs eligible hospitals and CAHs will be required to report on beginning with the CY 2026 reporting period.
CMS also issued the following notifications:
- Notified eligible hospitals and CAHs of the changes to the definition of CEHRT in the Medicare Promoting Interoperability Program at 42 CFR 495.4 beginning with the CY 2024 EHR reporting period based on revisions made in the CY 2024 Medicare Physician Fee Schedule final rule.
- Notified eligible hospitals and CAHs of the changes to the definition of Meaningful EHR User at 42 CFR 495.4, which become effective when the Department of Health and Human Services (HHS) final rule, 21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking (89 FR 54662) becomes effective on July 31, 2024.
The final rule includes an increase to the performance-based scoring threshold for eligible hospitals and CAHs reporting to the Medicare Promoting Interoperability Program from 60 points to 70 points for the CY 2025 EHR reporting period and from 70 points to 80 points beginning with the CY 2026 EHR reporting period.
Hospital Readmissions Reduction Program
The Hospital Readmissions Reduction Program is a type of value-based purchasing program that reduces payments to hospitals with excess readmissions. It also supports CMS’ goal of improving health care for patients by linking payment to the quality of hospital care. CMS did not propose and is not finalizing any changes to the Hospital Readmissions Reduction Program in the FY 2025 IPPS final rule. All previously finalized policies under this program will continue to apply and readers are referred to the FY 2023 IPPS PPS final rule (87 FR 49081 through 49094) for information on these policies.
Hospital-Acquired Condition (HAC) Reduction Program
The HAC Reduction Program creates an incentive for hospitals to reduce the incidence of hospital-acquired conditions by reducing payment by one percent for applicable hospitals that rank in the worst-performing quartile on select measures of hospital-acquired conditions. CMS did not propose and is not finalizing any changes to the HAC Reduction Program in the FY 2025 IPPS final rule. All previously finalized policies under this program will continue to apply and readers are referred to the FY 2024 IPPS final rule (88 FR 59108 through 59114) for information on these policies.
Hospital Value-Based Purchasing (VBP) Program
The Hospital VBP Program is a budget-neutral program funded by reducing participating hospitals’ base operating DRG payments each fiscal year by two percent and redistributing the entire amount back to the hospitals as value-based incentive payments. In the FY 2025 IPPS final rule, CMS is finalizing the proposals to:
- Modify scoring on the HCAHPS Survey measure in the Person and Community Engagement Domain for the FY 2027 through FY 2029 program years to only score on the six unchanged dimensions of the survey while updates to the survey are adopted and publicly reported in the Hospital IQR Program.
- Adopt sub-measure updates to the HCAHPS Survey measure in the Person and Community Engagement Domain beginning with the FY 2030 program year after the updates have been publicly reported for one year in the Hospital IQR Program.
- Modify scoring on the HCAHPS Survey measure in the Person and Community Engagement Domain beginning with the FY 2030 program year to account for the updates to the survey.
Hospital and CAH Respiratory Infection Data Reporting
CMS is renewing and revising the hospital and critical access hospital (CAH) Conditions of Participation (CoPs) data reporting requirements for data related to respiratory infections. Specifically, CMS is requiring that, beginning on November 1, hospitals and CAHs electronically report information about COVID-19, influenza and RSV on a schedule specified by the Secretary.
CMS is also requiring that, in the event of a declared PHE for an acute respiratory illness, the Secretary may require reporting of additional categories, such as: facility structure and infrastructure operational status; hospital/ED diversion status; staffing and staffing shortages; supply inventory shortages; and relevant medical countermeasures and therapeutics. The frequency and format of these additional data measures are at the discretion of the Secretary.
For more information on the 2025 IPPS final rule, please click on the following link: FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule –- CMS-1808-F | CMS.