Health Information Management

CMS focuses on quality measures in 2015 IPPS final rule

HIM-HIPAA Insider, August 11, 2014

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CMS’ recently released 2015 IPPS final rule focuses on quality initiatives mandated by the Affordable Care Act (ACA), including updates to Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program.

CMS will increase the applicable percent reduction to 1.5% of base operating DRG payment amounts to all participating hospitals as part of the VBP program. For FY 2017, CMS will add two new safety measures and one new clinical care-process measure, which will result in domain weighting revisions. In addition, CMS will adopt one new hospital-level risk-standardized complication rate following elective hip and knee arthroplasty measure with a 30-month performance period for FY 2019 and a 36-month performance period for FY 2020.
CMS finalized the scoring method for calculating a HAC score for each hospital. The score consists of two domains. The first is based on Patient Safety Indicator (PSI) 90, an administrative claims based measure. The second domain is based on central line-associated blood stream infections and catheter-associated urinary tract infections. For FY 2016 a third healthcare associated infection measure, surgical site infections, will be added to the program in domain 2.
CMS finalized an increase in the Hospital Readmissions Reduction Program maximum penalty, raising it from 2% to 3%, as required by the ACA. It also finalized an updated method to account for planned readmissions and determined that it will add readmissions for coronary artery bypass graft (CABG) surgical procedures to the list for FY 2017.
CMS is finalizing a total of 63 measures (47 required and 16 voluntary electronic clinical quality measures) in the Hospital Inpatient Quality Reporting Program measure set for the FY 2017 payment determination and subsequent years. CMS reduced the number of required measures from 57 to 47 and added 11 new measures (one chart-abstracted, four claims-based, and six voluntary electronic clinical quality measures).
CMS will make another -0.8% documentation and coding adjustment to continue the process of recovering overpayments as outlined in the American Taxpayer Relief Act of 2012.
CMS finalized its proposal to create two MS-DRGs for endovascular cardiac valve replacements and replace MS-DRG 490 and 491 with three new MS-DRGs. It also removed seven additional diagnosis codes to MS-DRG 794 (neonate with significant problems).
CMS will publish the final rule in the Federal Register August 22. A display copy is available online.
Read more on the HCPro website.

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