APIC and SHEA support "realistic" movement to align quality and reimbursement

January 12th, 2015

Two of the nation’s leading infection prevention groups expressed support for the increasing alignment of reimbursement with clinical quality improvement, though warning that the electronic reporting required in this process is going to be something of a work in progress.

The Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) commented on the Centers for Medicare & Medicaid Services planned 2013 Medicare hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system quality reporting programs.

“We are pleased that CMS continues to demonstrate its commitment to improving the quality of patient care and we believe CMS is moving in the right direction,” APIC and SHEA said. “…We emphasize that reducing the burden of reporting allows for enhancement of time spent on clinical infection prevention and control activities which can help improve patient outcomes. However we also need to be able to realistically evaluate the ability of facilities to submit such data electronically.”

A recent survey from New York State noted that only 15% of hospitals had adopted an Electronic Health Record (EHR) and many of those organizations that do have an EHR have not yet been able to validate the collection of denominator data electronically.

“While we recognize that outpatient facilities may be more advanced in their electronic capability then acute care hospitals, there may also be greater variability and potentially less information systems and technology resources that need to be accounted for during implementation,” the groups commented. “ It is also important to ensure that any data systems developed for submission accommodate pilot testing, reliability analysis, and validation components as part of the process.”