Thursday, 02 June 2016 05:57

CMS Continues Shift to Electronic Reporting and Cost Efficiency in Proposed Rule

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The Centers for Medicare & Medicaid Services (CMS) proposed multiple changes to quality reporting programs for hospitals in the 2017 Inpatient Prospective Payment System (IPPS) Proposed Rule, CMS-1655-P, which was posted to the Federal Register on April 27, 2016. Public comments are due by June 17, 2016, with the final rule expected to be published in August 2016. This article summarizes the most substantive proposed changes for five hospital quality reporting programs.

 

Hospital Readmission Reduction Program
Starting on page 25,094

In 2016 there were 3,464 hospitals in the Hospital Readmission Reduction Program (HRRP).  Of those, 2,665 received penalties for excess readmissions, totaling approximately $420 million. Twenty-three percent of participating hospitals had no penalty. The maximum allowable penalty of 3 percent was assigned to only 38 hospitals.

In the previous 2016 IPPS rule, the HRRP was expanded to include the isolated coronary artery bypass graft (CABG) population beginning in 2017. The 2016 rule specified the expansion of the pneumonia measure cohort in 2017 to include principal diagnosis codes for aspiration pneumonia and patients with a principal diagnosis of non-severe sepsis with a secondary diagnosis of pneumonia, in addition to those with only a principal diagnosis of viral or bacterial pneumonia. The expanded pneumonia cohort is expected to increase qualifying cases by as much as 50 percent in many hospitals. 

There were no new clinical cohorts proposed for future years in the IPPS 2017 Proposed Rule, leaving the following six measures in the HRRP for 2017 and beyond:

  • Acute MI 30-Day, All-Cause, Risk-Standardized Readmission Rate
  • Heart Failure 30-Day, All-Cause, Risk-Standardized Readmission Rate
  • Pneumonia (expanded) 30-Day, All-Cause, Risk-Standardized Readmission Rate
  • COPD 30-Day, All-Cause, Risk-Standardized Readmission Rate
  • Total Hip or Knee Arthroplasty 30-Day, All-Cause, Risk-Standardized Readmission Rate
  • CABG 30-Day, All-Cause, Risk-Standardized Readmission Rate   

The applicable discharges for 2017 will be those from July 1, 2012 to June 30, 2015, and the maximum allowable penalty will remain capped at 3 percent of a hospital’s Medicare payment.    

Hospital-Acquired Conditions Reduction Program
Starting on page 25,117

The most significant change proposed in the IPPS rule for the Hospital Acquired Conditions (HAC) Reduction Program is the adoption of the modified AHRQ PSI-90 Composite Measure, beginning with payment determination for 2018. Previously, this measure, called “Patient Safety for Selected Indictors,” contained eight individual measures, and this will now be expanded to 10. Three measures have been added, while PSI 7 Central-line Associated Blood Stream Infections (CLABSI) has been removed due to redundancy with the HAC Reduction Program, as well as across other programs where this measure is being reported.  The proposed rule also calls for a modification in the measure name to “Patient Safety and Adverse Events Composite.” 

The modified AHRQ PSI-90 Composite Measure contains the following measures:

  • PSI 3 Pressure Ulcer Rate
  • PSI 6 Latrogenic Pneumothorax
  • PSI 8 Post-op Hip Fracture Rate
  • PSI 9 Post-op Hemorrhage or Hematoma (new)
  • PSI 10 Physiologic/Metabolic Derangement (new)
  • PSI 11 Post-op Respiratory Failure (new)
  • PSI 12 Post-op PE or DVT
  • PSI 13 Post-op Sepsis Rate
  • PSI 14 Wound Dehiscence Rate
  • PSI 15 Accidental Puncture/Laceration

Note: The risk-adjustment methodology for the modified AHRQ PSI-90 Composite measure includes substantial revisions, which include weightings for degree of harm in addition to volume.


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Last modified on Friday, 03 June 2016 06:11

Vicky Mahn-DiNicola is Vice President of Research and Market Insights at Midas+ Xerox, where she serves as a speaker, author and clinical consultant in the areas of healthcare analytics, quality improvement, regulatory reporting and healthcare transformation. A Certified Lean Six Sigma Black Belt, Ms. Mahn completed her undergraduate and post graduate studies at the University of Arizona, where she continues to serve as Adjunct Faculty.