June 17, 2022

The Honorable Chiquita Brooks-LaSure
Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
P.O. Box 8013
Baltimore, MD  21244-1850

SUBJECT:  RE: CMS-1771-P, Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation: Proposed Rule (Vol. 87, No. 90), May 10, 2022.

Dear Administrator Brooks-LaSure:

On behalf of The Hospital and Healthsystem Association of Pennsylvania (HAP), which represents approximately 235 member institutions, we appreciate the opportunity to comment about the Centers for Medicare & Medicaid Services’ (CMS) hospital inpatient prospective payment system proposed rule for federal fiscal year (FFY) 2023.

HAP is extremely concerned with CMS’ proposed payment update of only 3.2 percent, 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 Disproportionate Share Hospital and other payments. 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 more than two 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 providing essential services for their communities.

Separately, CMS proposes to use more than one year of data to determine uncompensated care costs. We have long stated that utilizing a single year of S-10 data may increase the potential for anomalies and undue fluctuations in uncompensated care payments, especially when hospitals experience unforeseen circumstances such as a pandemic.

Finally, we thank CMS for recognizing that the COVID-19 pandemic continues to affect hospital performance in its quality measurement and value programs, and appreciate its proposal not to penalize hospitals for non-representative performance under the Hospital-Acquired Condition Reduction and Value-Based Purchasing Programs for fiscal year 2023. Hospitals and health systems share CMS’ deep commitment to advancing health equity. We look forward to reviewing the details of CMS’ proposed health equity-related quality measures and further engaging on how to advance this vital work.

The following comments provide areas of emphasis that HAP otherwise incorporates by referencing all comprehensive comments submitted by the American Hospital Association.

Thank you for your consideration of HAP’s following comments regarding this proposed rule. If you have any questions, contact Kate Slatt, vice president, innovative payment and care delivery, at (717) 561-5317.

Sincerely,

Jeffrey W. Bechtel
Senior Vice President, Health Economics and Policy

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