Report data for 10 quality measures to receive full reimbursement under IPPS
HIM Connection, September 28, 2004
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The inpatient prospective payment system (IPPS) rule ties quality to reimbursement for the first time. The Centers for Medicare & Medicaid Services expects widespread participation in the effort to collect 10 proven hospital quality measures in three clinical conditions-acute myocardial infarction, heart failure, and pneumonia. Hospitals that do not provide the data will receive 0.4% less reimbursement per case.
To receive full reimbursement under the inpatient prospective payment system (IPPS) report data for the following 10 measures:
- Acute myocardial infarction (AMI) patients without aspirin contraindications who received aspirin within 24 hours before or after hospital arrival
- AMI patients without aspirin contraindications who are prescribed aspirin at hospital discharge
- AMI patients with left ventricular systolic dysfunction (LVSD) and without angiotensin converting enzyme inhibitor (ACEI) contraindications who are prescribed ACEI at hospital discharge
- AMI patients without beta blocker contraindications who received a beta blocker within 24 hours after hospital arrival
- AMI patients without beta blocker contraindications who are prescribed a beta blocker at hospital discharge
Heart failure
- Heart failure patients with documentation in the hospital record that left ventricular function was assessed before arrival, during hospitalization, or is planned for after discharge
- Heart failure patients with LVSD and without ACEI contraindications who are prescribed an ACEI at hospital discharge
Pneumonia
- Pneumonia patients who receive their first dose of antibiotics within four hours after arrival at the hospital
- Pneumonia patients age 65 and older who were screened for pneumococcal vaccine status and were administered the vaccine prior to discharge, if indicated.
- Pneumonia patients who had an assessment of arterial oxygenation by arterial blood gas measurement or pulse oximetry within 24 hours prior to or after arrival at the hospital.
Acute myocardial infarction
Whether the clinical documentation is in the hospital or the physician office record, it must be complete and accurate to meet medical necessity requirements, comply with coding and billing rules, ensure proper reimbursement, and gather outcomes data.
This excerpt is adapted from The 2005 ICD-9-CM Training Kit.
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