Health Information Management

CMS focuses on quality measures in FY 2016 IPPS proposed rule

HIM-HIPAA Insider, April 27, 2015

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CMS released its fiscal year (FY) 2016 IPPS proposed rule April 17, announcing potential changes to MS-DRGs, the market basket update, and value-based payment quality measures.

CMS proposed refining the pneumonia readmission measure to expand the measure cohort and the formal adoption of an extraordinary circumstance exception (ECE) policy. CMS proposed to amend the readmission cohort to include these excluded cases, effective with the FY 2017 payment determination.
The rule also included a Hospital Value-Based Purchasing (HVBP) Program proposal that would remove two measures (IMM-2, Influenza Immunization, and AMI-7a, Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival). If the measures are removed, CMS will move PC-01 (Elective Delivery) to the Patient Safety domain and to remove the Clinical Care—Process subdomain for FY 2018 and beyond. The Patient Safety domain will have an increased weight in the HVBP scoring methodology in FY 2018 (from 20% to 25%).
The proposed rule indicates that CMS anticipates 19.4% of hospitals will be penalized with a 1% reduction in MS-DRG payments for all traditional Medicare discharges in FY 2016 due to Hospital-Acquired Condition (HAC) Reduction Program (HACRP) performance.
CMS is proposing three changes to the HACRP:
  • Expanding the population covered by Central Line-Associated Bloodstream Infection and Catheter-Associated Urinary Tract Infection measures from ICU locations to select medical and surgical wards in FY 2018
  • Adjusting the relative contribution of each domain to the total HAC score
  • Adding an ECE policy
CMS proposed removing nine measures from the Hospital Inpatient Quality Reporting (IQR) Program, including six “topped out” measures. Those topped out measures are:
  • STK-01, Venous Thromboembolism (VTE) Prophylaxis for Patients with Ischemic or Hemorrhagic Stroke
  • STK-06, Discharged on Statin Medication
  • STK-08, Stroke Education
  • VTE-1, Venous Thromboembolism Prophylaxis
  • VTE-2, Intensive Care Unit Venous Thromboembolism Prophylaxis
  • VTE-3, Venous Thromboembolism Patients with Anticoagulation Overlap Therapy
In addition, CMS included mention of ICD-10-CM/PCS in the proposed rule and requested comments on the potential implementation of bundled payments for inpatient care, which is required by the Patient Protection and Affordable Care Act to be announced no later than January 1, 2016. CMS signaled its belief that ICD-10 will be implemented October 1, 2015, by using ICD-10 codes in discussion of MS-DRG changes
The 2-midnight rule has been a hot topic in recent IPPS and OPPS final rules, but few changes were noted in the FY 2016 IPPS proposed rule. The Medicare Access and CHIP Reauthorization Act of 2015 further extended probe and educate audits of the 2-midnight rule to September 30, 2015. CMS will review short inpatient hospital stays, long outpatient stays with observation services, and the related -0.2% IPPS payment adjustment, but noted that additional information about the 2-midnight rule and these reviews will likely appear in the FY 2016 OPPS proposed rule.
CMS is accepting comments on the proposed rule until June 16, 2015.
Click here to read more on the HCPro website.



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