Health Information Management

Ask the expert: What are some of the major highlights of the 2009 IPPS proposed rule?

HIM Connection, April 22, 2008

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A: Perhaps the greatest change pertains to quality indicators and hospital acquired conditions (HAC). For FY 2009, CMS proposes to expand the current list of eight HACs to 17 and include the following nine additional conditions (CMS will not yield a higher-paying DRG when the patient acquires one of these conditions during the inpatient stay):

  • Surgical site infections following certain elective procedures
  • Legionnaires' disease
  • Extreme blood sugar derangement
  • Iatrogenic pneumothorax
  • Delirium
  • Ventilator-associated pneumonia
  • Deep vein thrombosis/Pulmonary embolism
  • Staphylococcus aureus-associated disease
  • Clostridium difficile-associated disease

CMS also proposes to add 43 new quality measures to the existing 30 for FY 2009, bringing the total number of measures to 73. Reporting all of these measures qualifies hospitals to receive a full update to their FY 2009 payment rates. Hospitals that don't successfully report these measures will receive an update of 1% which is two percentage points less than the full update. The new measures include the following:

  • Surgical Care Improvement Project (one new measure)
  • Hospital readmissions (three new measures)
  • Nursing care (four new measures)
  • Patient safety indicators developed by the Agency for Healthcare Research and Quality (AHRQ) (five new measures)
  • Inpatient quality indicators developed by AHRQ (four new measures)
  • Venous thromboembolism (six new measures)
  • Stroke measures (five new measures)
  • Cardiac surgery measures (15 new measures)

To view the proposed rule, visit www.cms.hhs.gov/AcuteInpatientPPS/IPPS/.



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