Transcript Slide 1

Performance Measures:
CMS Hospital Inpatient Quality
Reporting Program (IQR)Update
As of November 2012
CMS Inpatient
Prospective
Payment
System
(IPPS)
Payment Rates*
Wage index, files, and reform
Outlier payments
Disproportionate Share (DSH)
Direct Graduate Medical Education (DGME)
Indirect Medical Education (IME)
New Medical Services and New Technologies
Three Day Payment Window
Hospital Value Based Purchasing Program
Readmissions Reduction Program
Hospital Acquired Conditions
Inpatient Quality Reporting (IQR) Program
*Inpatient only procedures are covered under the Outpatient Prospective Payment System (OPPS)
Inpatient Quality Reporting (IQR)Program
• Developed out of the Medicare Prescription
Drug, Improvement, and Modernization Act
(MMA) of 2003
• Deficit Reduction Act (DRA) of 2005 gave
new requirements
– Inpatient Prospective Payment System (IPPS) pays
hospitals an incentive for reporting measures
which is referred as the Annual Payment Update
(APU)
 Intent is to encourage hospitals to submit accurate,
complete, and timely data reflecting the hospitals
ability to adopt evidence based, outcomes driven health
care delivery practices
IQR Connected to
Reimbursement
Hospital Receives
Full CMS Payment
Update
Submit IQR
Reporting
Measures
(Market Basket)
Data Passes
Validation
Review
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Changes to Inpatient CMS Measures
Future CMS Measures
Previous Measures Approved for 2013
Alignment with National Quality Strategy
**Updates in RED**
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Changes to Inpatient CMS Measures
Future CMS Measures
Previous Measures Approved for 2013
Alignment with National Quality Strategy
CMS Measures: Inpatient - Old
• Surgical Care Improvement Project
(SCIP) (abstracted)
– Surgical patients with recommended VTE prophylaxis ordered
(removed from IQR FY15 because no longer recommended for endorsement)
• Hospital Acquired Conditions
(claims data)
(removed due to duplication of HAC reporting)
- Air embolism (removed from IQR FY15)
– Blood incompatibility (removed from IQR FY15)
– Catheter associated urinary tract infection (removed from IQR FY15)
– Falls and trauma (removed from IQR FY15)
– Foreign object retained after/during surgery (removed from IQR FY15)
– Manifestations of poor glycemic control (removed from IQR FY15)
– Pressure ulcers stage III and IV (removed from IQR FY15)
– Vascular catheter associated infections (removed from IQR FY15)
Note: FY15 is for CY 2013 data collection
CMS Measures: Inpatient - Old
• Association of Healthcare Quality and
Research (AHRQ)Indicators (claims data)
– Abdominal aortic aneurysm (AAA) repair mortality
rate (with or without volume) (removed from IQR FY15)*
– Hip fracture mortality rate (removed from IQR FY15)*
– Mortality for selected medical conditions (removed from IQR
FY15)*
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Iatrogenic pneumothorax (removed from IQR FY 15)**
Postoperative wound dehiscence (removed from IQR FY15)**
Accidental puncture or laceration (removed from IQR FY15)**
Post operative respiratory failure (removed from IQR FY15)***
Post operative pulmonary embolism/deep vein
thrombosis (removed from IQR FY15)**
*Removed to reduce redundancy and overlap with other measures, ** removed because
included in the PSI composite that remains in IQR, ***removed due to better analysis by NHSN
data later
CMS Measures: Inpatient - New
• Patient’s Experience of Care (HCAHPS)*
– 3 item care transition set
(Added to IQR FY 15)
 Staff took my/family/caregiver preferences into account in
deciding on my health care needs when I left
 When I left the hospital, I had an understanding of things I
was responsible for managing my health
 When I left the hospital, I clearly understood the purpose for
taking each of medications
– About you items
(Added to IQR FY 15)
 Were you admitted to the hospital through the ER?
 How would you rate your overall mental or emotional health?
*Added in July 2012 by our organization
CMS Measures: Inpatient - New
• Claims Based Readmission Measures
– 30 day risk standardized readmission following
total hip/knee arthroplasty(Added to IQR FY 15)
– Hospital wide all cause unplanned readmission
(Added to IQR FY 15)
• Claims Based Complication Measure
– Hospital level risk standardized complication rate
following elective primary total hip arthroplasty
(Added to IQR FY 15)
• Chart Abstracted Measure
– Elective delivery prior to 39 completed weeks of
gestation (Added to IQR FY 15)
Note: FY15 is for CY 2013 data collection
CMS Measures: Inpatient - New
• Safe Surgery Checklist
(Added to IQR FY16)
– Hospital inpatient department indicates whether or
not it uses a safe surgery checklist for procedures
during three timeframes (1) time prior to
administration of anesthesia (2) time prior to skin
incision and (3) time of closure of incision and prior to
patient leaving the operating room
Note: FY16 is for CY 2014 data collection
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Changes to Inpatient CMS Measures
Future CMS Measures
Previous Measures Approved Next Year
Alignment with National Quality Strategy
CMS Measures: Inpatient - New
• Future Measures
– Tobacco cessation
(No Date Set)
 Screening, treatment provided, treatment management
at discharge, assessment of status after discharge
– Alcohol cessation
(No Date Set)
 Screening, brief intervention provided, disorder
treatment provided/offered at discharge, assessment
of status after discharge
– Central line associated bloodstream infections of
non-ICU patients (No Date Set)
– Catheter associated urinary tract infections of
non-ICU patients (No Date Set)
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Changes to Inpatient CMS Measures
Future CMS Measures
Previous Measures Approved for 2013
Alignment with National Quality Strategy
Previous Measures Approved: Inpatient -2013
• Healthcare Associated Infections
(IP/NHSN data)
 Methicillin Resistant Staphylococcus Aureus (MRSA)
bacteremia (Added to IQR FY 15)
 C. Difficile standardized infection ratio (Added to IQR FY 15)
 Influenza vaccination coverage among health care
personnel (Added to IQR FY 15)
• Stroke Measures (Added to IQR FY 15)
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VTE prophylaxis
Antithrombotic therapy for ischemic stroke
Anticoagulation therapy for A-fib/flutter
Thrombolytic therapy for acute ischemic stroke
Antithrombotic therapy by the end of hospital day 2
Discharged on statin
Stroke education
Assessed for rehab
Note: FY15
is for CY
2013 data
collection
Previous Measures Approved: Inpatient -2013
• Venous Thromboembolism(VTE)(Added to IQR FY 15)
VTE prophylaxis
ICU VTE prophylaxis
VTE patients with anticoagulation overlap therapy
VTE patients receiving unfractionated Heparin with
dosages/platelet count monitoring by protocol
 VTE discharge instructions
 Incidence of potentially preventable VTE
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Note: FY15 is for CY 2013 data collection
Previous Measures Approved in IQR for
Outpatient - 2013
• Outpatient
– Safe surgery checklist use
(Attestation in July 2013 for Jan-Dec
2012)
– Hospital outpatient volume data on selected
outpatient surgical procedures (Report volume of cases in
Jul 2013 for Jan-Dec 2012)
– Cardiac rehabilitation patient referral from an
outpatient setting (DEFERED until 2014)
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Changes to Inpatient CMS Measures
Future CMS Measures
Previous Measures Approved for 2013
Alignment with National Quality Strategy
Selection of Future Measures
• Align with National Quality Strategy
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Clinical quality
Care coordination
Patient safety
Patient/caregiver experience of care
Population/community health
Efficiency
Questions
For more information regarding the CMS FY 15
and FY 16 IQR Program measures visit
https://www.cms.gov/Medicare/MedicareFee-for-Service
Payment/AcuteInpatientPPS/FY-2013-IPPSFinal-Rule-Home-Page.html