CMS Continues Emphasis on Quality, Value-based Purchasing
IPPS proposed rule asks for input on simplifying Medicare
EXECUTIVE SUMMARY
In the Inpatient Prospective Payment System proposed rule, CMS is asking for public input on how to ease the burdens on providers and how make the healthcare system less complex and bureaucratic.
- The proposed rule also asks for input on additional measures that hospitals will have to report under the Hospital Inpatient Quality Reporting Program, including measures on safe use of opioids, malnutrition screening and treatment, and screening and interventions around alcohol and tobacco use.
- CMS proposes that Medicare spending-per-beneficiary performance account for 50% of hospitals’ Efficiency and Cost Reduction scores in the Value-Based Purchasing Program and that each of the four domains — safety, clinical care, efficiency and cost reduction, and person and community engagement — comprise 25% of a hospital’s overall score.
- As directed by the 21st Century Cures Act, CMS proposed to calculate penalties under the Hospital Readmission Reduction Program by comparing hospitals’ performance with other hospitals that have a similar population of patients who are dually eligible for Medicare and Medicaid.
In the Inpatient Prospective Payment System (IPPS) proposed rule for fiscal 2018, CMS repeated its commitment to transforming the healthcare delivery system with an emphasis on patient-centered care, and asked for public input on making the healthcare system less bureaucratic and complex.
The proposed rule, issued April 14, includes a request for public input on how to “ease the burden that prior policies have put on clinicians.” The agency is asking for ideas on regulatory, policy, practice, and procedural changes.
“We would like to start a national conversation about improving the healthcare delivery system, how Medicare can contribute to making the delivery system less bureaucratic and complex, and how we can reduce the burden for clinicians, providers, and patients in a way that increases quality of care and costs,” CMS stated in a media release. Although CMS is taking comments on what would ease burdens and address needs, it will not comment on the public input in the final rule but will consider it when it develops future regulatory proposals or sub-guidance, says Donna Hopkins, MS, RN, CMAC, vice president at Novia Strategies, a national healthcare consulting firm.
CMS is proposing a lot of changes, particularly with quality and efficiency measures, but the measures that are ending or transitioning, and the new measures, do not appear to be easing any burdens, Hopkins says. “The details are still not finalized, but they are likely to have a direct impact on what the case management staff does,” she says.
CMS is asking for input on additional measures for future reporting under the Hospital Inpatient Quality Reporting Program and on updating the extraordinary circumstances exception policy for fiscal 2019. The proposed rule includes a list of possible new quality measures that CMS is considering for future years, according to Deborah K. Hale, CCS, CCDS, president of Administrative Consultant Services, a Shawnee, OK, healthcare consulting firm.
In the proposed rule, CMS says it wants to adopt measures for the Hospital Inpatient Quality Reporting Program to promote better, safer, more efficient care, expand the pool of measures, improve patient safety, and support the National Quality Forum’s triple aim of better healthcare for individuals, better health for populations, and lower costs for healthcare by creating transparency around the quality of care.
The document lists potential quality measures that include safe use of opioids, several measures related to malnutrition, tobacco use screening, and alcohol use screening and interventions for both.
The proposed rule calls for Medicare spending per beneficiary to make up 50% of hospitals’ Efficiency and Cost Reduction scores in the Value-Based Purchasing Program, Hale points out. Beginning in fiscal 2019, CMS proposes that each of the four domains — safety, clinical care, efficiency and cost reduction, and person and community engagement — make up 25% of a hospital’s overall score.
If quality measures are not well-understood and managed appropriately, hospitals could lose out under Value-Based Purchasing, Hopkins says.
“Hospitals are assuming more risk for patient care, and case managers, as facilitators of care coordination, need to be in sync with quality departments in order for hospitals to ensure the appropriate reimbursement for the services they provide. Case managers are perfectly positioned to financially impact improved care coordination throughout the acute episode and throughout the continuum,” Hopkins says.
A major change in the proposed rule alters the way payment reductions are calculated under the Hospital Readmission Reduction Program. Beginning in fiscal 2019, CMS proposes to assess penalties based on a hospital’s performance compared to other hospitals that have a similar proportion of patients who are dually eligible for Medicare and Medicaid. The 21st Century Cures Act, passed by Congress in December 2016, requires CMS to take socioeconomic factors into account when calculating penalties related to readmissions.
“CMS is trying to better weigh data based on the percentage of dual eligible patients a hospital admits and benchmark hospitals with similar percentages. The methodology for adjusting for dual eligible is a first attempt by CMS to acknowledge the high cost of this needful population and, thus, the impact to readmission penalties,” Hopkins says.
“The proposed rule is also taking first stabs at addressing end-of-life issues for certain oncology patient management and intensive care unit utilization and is seeking transparency of accrediting body reports and corrective action plans. It will be interesting to see if these measures make it into the final rule,” Hopkins adds.
CMS proposes that hospitals that report quality data and participate in meaningful use of electronic health records receive a 2.9% increase in Medicare operating rates. The agency projects that total Medicare spending will increase by $3.1 billion in fiscal 2018.
In the Inpatient Prospective Payment System proposed rule, CMS is asking for public input on how to ease the burdens on providers and how make the healthcare system less complex and bureaucratic.
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