CMS emphasizes quality patient care
Executive Summary
The Inpatient Prospective Payment System proposed rule for fiscal 2015 continues the Centers for Medicare & Medicaid Services’ move toward basing reimbursement on quality of care, not quantity.
• The rule also asks for public input on the two-midnight rule and a policy to address short-stay patients.
• CMS is implementing the Hospital-Acquired Condition Reduction Program, which penalizes hospitals that perform poorly.
• The agency proposes to add two safety measures to value-based purchasing in the future.
Proposed IPPS rule asks for input
In the Inpatient Prospective Payment System (IPPS) proposed rule for fiscal 2015, the Centers for Medicare & Medicaid Services (CMS) continued its emphasis on readmissions and patient safety and beefed up its initiatives that base reimbursement on quality improvement.
"Case managers can have a real impact on their hospital’s performance as CMS shifts its focus from basing reimbursement on quantity to reimbursing hospitals for better care and achieving better outcomes," says Deborah K. Hale, CCS, CCDS, president of Administrative Consultant Services, a Shawnee, OK-based healthcare consulting firm.
The proposed rule, issued April 30, reduces payments when certain hospital-acquired conditions occur and readmissions are more frequent than expected. CMS also announced potential changes to the Value-based Purchasing Program. After reviewing comments from the public, CMS will issue the final rule for fiscal 2015 by August 1. The rule will go into effect with discharges on or after Oct. 1, 2014.
In addition, the proposed rule asks for public input on changes to the controversial two-midnight policy, implemented in the final rule for fiscal 2014, which establishes a benchmark of two midnights for an appropriate inpatient admission.
As part of a bill to stave off scheduled cuts to Medicare physician payments, Congress delayed Recovery Auditor reviews of the two-midnight policy until after March 31, 2015, and directed CMS to work with members of the healthcare profession to develop a policy to address short-stay patients who need inpatient services but don’t need to be in the hospital over two midnights.
The proposed rule asks for input on how to define short inpatient stays and how to determine an alternative payment methodology for short stay inpatient cases.
In fiscal 2015, CMS proposes to implement the Hospital-Acquired Condition Reduction Program as required by the Affordable Care Act. This means that hospitals with the poorest performance (those in the bottom 25%) in the program will have their Medicare payments reduced by 1%, according to Hale.
The program tabulates hospital scores using two domains. The Patient Safety Indicator 90 is a composite of eight measures including pressure ulcers, iatrogenic pneumothorax, central venous catheter-related bloodstream infections, postoperative hip fracture, postoperative pulmonary embolism or deep venous thrombosis, postoperative sepsis, postoperative wound dehiscence, and accidental puncture or laceration. Domain 2 measures are two healthcare-associated infection measures—central line-associated bloodstream infection, and catheter-associated urinary tract infections, according to Hale.
"Data for the Hospital-Acquired Condition Reduction Program is risk-adjusted, which means that documentation should be complete and detailed and accurately reflect the severity of the patient’s illness, as well as identify any conditions that were present on admission," Hale says.
The proposed rule increases the penalty for the Hospital Readmissions Reduction Program to up to 3% for hospitals that experience excess readmissions within 30 days after discharge. In the past, the readmissions reduction program included acute myocardial infarction, pneumonia, and heart failure. In 2015, CMS is adding chronic obstructive pulmonary disease and total hip/total knee arthroplasty.
CMS proposes to add coronary artery bypass graft to readmission reduction in fiscal 2017.
In 2015, hospital payments will automatically be reduced by 1.5% to fund the CMS Value-based Purchasing Program. In the proposed rule, CMS estimates that $1.4 billion will be dispersed to hospitals based on how well they perform on the value-based purchasing metrics.
In the proposed rule, CMS announced its intention to add two measures to the new patient safety domain in value-based purchasing: methicillin-resistant Staphylococcus aureas bacteremia and clostridium difficile infection.
