CMS issues 2014 Medicare IPPS proposal

Recommendations include quality components

Late in April, the Centers for Medicare & Medicaid Services (CMS) released its proposed update to policies and payments for inpatient care in fiscal year 2014. Alongside payment updates, the proposal lays out the framework for a patient safety program to be launched in 2015 that is mandated by the Affordable Care Act, and it clarifies admission and medical review criteria for inpatient services.

The quality improvement and patient safety portions of the proposal include:

Reducing hospital-acquired conditions. Facilities that are in the lowest quartile related to this will lose 1% of their reimbursement. How facilities will be ranked is outlined in the proposal.

The conditions ranked include: pressure ulcer rate; volume of foreign object left in the body; iatrogenic pneumothorax rate; postoperative physiologic and metabolic derangement rate; postoperative pulmonary embolism or deep vein thrombosis rate; and accidental puncture and laceration rate. A composite measure set is also proposed as an alternative to these Domain 1 measures. Domain 2 measures include central line-associated blood stream infection and catheter-associated urinary tract infection.

Value–based purchasing. Incentive payments for performance based initiatives increase to 1.25%, and will total about $1.1 billion. It will also add new measures to the program.

Readmissions. Payment penalties related to unplanned readmissions increase from 1% to 2%. Two new readmission measures are added and may be used to calculate penalties for fiscal year 2015. Along with heart attack, heart failure, and pneumonia, CMS proposes adding readmissions for hip/knee arthroplasty and chronic obstructive pulmonary disease.

Quality reporting. The proposal updates measures for the Hospital Inpatient Quality Reporting (IQR) and other reporting programs, aiming to reduce the reporting burden by aligning measures with quality measure reporting requirements in the Medicare Electronic Health Record Incentive. IQR measures are published on the Hospital Compare website — — and may be added to the Value-Based Purchasing Program.

The current proposal includes 57 measures, including chart-abstracted measures, such as heart attack, heart failure, pneumonia, and surgical care improvement measures; claims-based measures such as mortality and readmissions; healthcare-associated infections measures; a surgical complications measure; survey-based measures, such as patient experience of care; immunization measures, and structural measures that assess features of hospitals—such as hospital volume, how the hospital deploys staff, or provider qualifications—to assess their capacity to improve quality of care. The proposal includes two new chart abstracted HAI measures: hospital-onset methicillin-resistant staphylococcus aureas (MRSA) bacteremia, and clostridium difficile, and reducing the number of records used for HAI validation from 48 to 36 patient charts.

Hospitals will also have the option of transmitting data electronically to meet validation requirements — electronically submit one quarter’s data for 16 quality measures from four measure sets, or submit a full year if not submitting electronically. CMS also proposes collection and reporting of this measure data through Certified Electronic Health Record Technologies (CEHRTs).

The proposed rules are available in the May 10, 2013, issue of the Federal Register. Hospital Peer Review will look into what the proposals mean for quality managers in the next issue.