CMS Increasing Required Data Reporting
With changes in the Centers for Medicare and Medicaid Services’ Inpatient Prospective Payment Systems, hospitals soon will be required to report more quality measures as part of CMS’ annual payment update. Since November 2004, BWH has participated in CMS’ voluntary reporting, which began with a limited set of 10 measures. During the last three years, the number of reportable measures has increased to 32.
In addition to requiring more reportable data measures, CMS has shifted its measures reporting policy. At first, limited data reporting was rolled out as a voluntary pilot program, and the data was not shared publicly. Now, more data is shared on the “Hospital Compare” Web site, and CMS has made the data reporting mandatory this fiscal year.
CMS’ Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) initiative requires hospitals to submit data for specific quality measures for health conditions common among people with Medicare, and which typically result in hospitalization. Hospitals that do not participate in this initiative will receive a reduction of 2 percent in their Medicare payment. For fiscal year 2007, CMS required that hospitals continue to submit data regarding the 10 quality measures for three medical conditions: acute myocardial infarction, heart failure and pneumonia. By FY08, the measures expanded to 21 including a fourth medical condition: surgical care improvement. For FY09, a complement of 32 quality measures will be required for hospitals to be eligible for their full annual payment update.
“As soon as next year, Medicare hospital payments may be tied to actual performance, not simply data reporting,” Michael Gustafson, MD, MBA, vice president for Clinical Excellence, said.
In recent years, BWH has included pay-for-performance provisions for these metrics in contracts with private payors, and the hospital has received all its withhold dollars based on meeting performance targets.
For FY08, the following inpatient data will be reported to CMS:
Acute Myocardial Infarction
Aspirin at arrival
Aspirin prescribed at discharge
ACEI or ARB for LVSD
Beta blocker prescribed at discharge
Adult smoking cessation advice/counseling
Beta blocker at arrival
Fibrinolytic therapy received within 30 minutes of hospital arrival
Primary PCI received within 90 minutes of hospital arrival
Heart Failure
Discharge instructions (must include documentation that patient was instructed to measure weight)
Evaluation of LVS Function
ACEI or ARB for LVSD
Adult smoking cessation advice/counseling
Pneumonia
Oxygenation assessment
Pneumococcal vaccination (patients older than 65)
Blood cultures performed in ED prior to initial antibiotic
Adult smoking cessation advice/counseling
Initial antibiotic received within 4 hours of hospital arrival
Initial antibiotic selection for CAP in immunocompetent patient
Influenza vaccination (patients older than 50 discharged Oct 1 thru March 1)
Surgical Care Improvement Project
Prophylactic antibiotic received within one hour of surgical incision
Prophylactic antiobotic selection for surgical patients
Prophylactic antibiotics discontinued within 24 hours after surgery end time
Surgery patients with recommended venous thromboembolism prophylaxis ordered
Surgery patients who received appropriate venous thromboembolism prophylaxis within 24 hours prior to or after surgery
30-Day Risk Adjusted Mortality Rates
Acute myocardial infarction
Heart failure
Patient Experience of Care: HCAHPS
Doctor communication
Nurse communication
Responsiveness of hospital staff
Cleanliness and quiet of hospital environment
Pain management
Communication about medicines
Discharge information
Overall rating of hospital
Overall willingness to recommend hospital
CMS announced the addition of 10 outpatient measures for 2008 as part of the Outpatient Prospective Payment System (OPPS) rule. This rule includes a requirement for hospitals to begin reporting data in 2008 on 10 outpatient quality measures endorsed by the Hospital Quality Alliance (HQA) in order to receive a full outpatient payment in 2009. The following outpatient measures will need to be reported by BWH:
ACEI or ARB Prescribed for clinic patients with LVSD
HgA1c measured in last 12 months for clinic patients with type 1 or 2 diabetes
Emperic antibiotic selection for community-acquired pneumonia (CAP) in immunocompetent clinic and ED patients
Prophylactic Antibiotic Initiated within one hour prior to surgical incision (outpatients)
Prophylactic antibiotic selection for outpatient surgical patients.