CMS seeks changes to Medicare's hospital quality reporting system

Hospitals that don't participate successfully in the voluntary Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program will see their market basket adjustment decreased by 2 percentage points in fiscal year 2011, according to the new inpatient prospective payment system (IPPS) proposed rule that the Centers for Medicare and Medicaid Services (CMS) placed on display April 19 at the Federal Register. For FY 2011, that would put these hospitals' market basket update at a measly 0.4 percent. While that's depressing, it's not breaking news. Hospital participation in the RHQDAPU program now stands at 99 percent, and 96 percent of participating hospitals are receiving the full update in FY 2010, says CMS.

The bigger news: CMS proposes to revise RHQDAPU reporting measures for 2011, which will impact the FY 2012 market basket update. Currently, 46 quality measures qualify hospitals to receive the full market basket update. CMS wants to retire one measure, Mortality for selected surgical procedures (composite), and add 10 new measures for a total set of 55 measures that hospitals will have to report in 2011 for the FY 2012 update.

The 10 new measures would include these eight condition categories from the hospital-acquired conditions list:

• Foreign object retained after surgery;
• Air embolism;
• Blood incompatibility;
• Pressure ulcer stages III and IV;
• Falls and trauma (including fracture, dislocation, intracranial injury, crushing injury, burn, and electric shock);
• Vascular catheter-associated infection;
• Catheter-associated urinary tract infection (UTI); and
• Manifestations of poor glycemic control.

CMS also would add two Patient Safety Indicators developed by the Agency for Healthcare Research and Quality: post-operative respiratory failure and post-operative pulmonary embolism or deep-vein thrombosis.

In addition, CMS seeks to collect another 35 new measures (collected largely via registries) that would be used to finalize FY 2013 market basket updates.

To learn more:
- read this CMS fact sheet on proposals for improving quality of care in inpatient acute-care stays
- download the public inspection documents from the Federal Register

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