- CMS proposes a 2.4% rise in inpatient hospital payments for FY 2027, contingent on participation in quality reporting and EHR programs.
- The special pathway for breakthrough devices would be removed, requiring all technologies to meet the same approval criteria.
- Minor updates are proposed for IQR and Value-Based Purchasing programs, potentially affecting cardiothoracic surgery metrics.
- New rules would require electronic prior authorization, faster decisions, and greater transparency for drug approvals.
- STS is reviewing all proposals and will submit feedback on impacts to surgeons and patient care.
Last week, the Centers for Medicare & Medicaid Services (CMS) published the Fiscal Year (FY) 2027 Inpatient Prospective Payment System (IPPS) proposed rule. STS has compiled a summary of the rule’s key provisions affecting cardiothoracic surgery.
Payment Updates and Hospital Reimbursement
CMS is proposing an increase to hospital inpatient payments of 2.4% over 2026 levels. Hospitals must successfully participate in the Inpatient Quality Reporting (IQR) program and be meaningful users of an electronic health record (EHR) to receive the full rate update.
New Technology Add-On Payments
CMS proposes eliminating the alternate pathway for IPPS new technology add-on payments, requiring devices with breakthrough device designation (BDD) to meet the same eligibility criteria as non-BDD technologies. STS will review how this policy change could impact patient access to cardiothoracic devices.
Quality and Value-Based Programs
Within both the IQR Program and the Hospital Value-Based Purchasing Program, CMS is making minor adjustments to quality measures affecting cardiothoracic surgeons. STS will review all proposed changes to ensure they do not negatively impact physician performance.
Prior Authorization for Drugs
Along with the inpatient rule, CMS also released the 2026 CMS Interoperability Standards and Prior Authorization for Drugs proposed rule. This regulation builds on previous efforts by requiring impacted payers to support electronic prior authorization, make decisions within shorter timeframes that align across CMS programs, and increase transparency for the prior authorization of drugs.
STS is reviewing all proposals in both rules and will provide written comments to CMS on policies impacting cardiothoracic surgeons and their patients.