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The goods buried within Medicare's hospital rule

Mark Lennihan / AP

Medicare's final 2018 hospital payment rule set in stone a spate of policies — ranging from a withdrawn proposal that would have required accrediting bodies to make confidential hospital inspections public to a new (and unpopular) system for calculating hospitals' uncompensated care.

But a handful of other payment policy changes also will go into effect next year, pleasing the various companies and industries that lobbied the Centers for Medicare and Medicaid Services.

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Smaller payment cut for heart devices: Medicare proposed updating its payment system based on new medical coding data, and payments for the "other heart assist system implant" reimbursement code would have been slashed by almost 35%. The cut would have especially affected Abiomed, a company that makes heart devices.

Hospitals using that code and Abiomed's heart device are currently paid about $96,000 per treatment, and it would have been reduced to about $63,000. Abiomed lobbied Medicare officials in July to blunt the cut. Medicare agreed, and now the payment will reduced by a lower 19% rate for 2018.

Here are other nuggets embedded within Medicare's final inpatient rule, the first under Department of Health and Human Services secretary (and orthopedic surgeon) Tom Price:

  • Big Ankle: Medicare officially will pay more for total ankle replacements. This will benefit ankle surgeons and medical device companies that make ankle implants.
  • More on heart devices: Medicare approved add-on payments for two heart valve devices — one made by Edwards Lifesciences and the other by LivaNova. Each hospital case that uses the devices will get an additional $6,100, which could incentivize hospitals to use those devices.
  • J&J drug: Hospitals that use Johnson & Johnson's new IV drug, Stelara, for patients with Crohn's disease will receive an add-on payment of $2,400 per case.
  • Merck drug: Hospitals that use Merck's new anti-infective drug, Zinplava, for patients with an infection called Clostridium difficile will get an additional $1,900 per case.
  • Newspaper notices: Ambulatory surgery centers and clinics will no longer have to put a notice in a print newspaper if they get terminated from the Medicare program, but will still have to alert the public through websites or other media.
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