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Medicare News
Medicare Says Most Acute Care Hospitals Meet
Standards for Full Rate Increase
Senior citizens encouraged to use information as
snapshot of the quality of care being delivered
Oct. 11, 2007 – Medicare reported today that the
“vast majority of the nation’s hospitals” are reporting “valuable data”
about the quality of the care they provide to Medicare beneficiaries and
will receive a full payment rate increase of 3.3 percent next year.
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Under the Reporting Hospital Quality Data for
Annual Payment Update (RHQDAPU) program, hospitals that reported certain
quality measures and met other requirements are entitled to receive the
full market basket update for FY 2008, according to an announcement
today by Kerry Weems, acting administrator of the Centers for Medicare &
Medicaid Services.
Although participation in the program is voluntary,
section 5001(a)(2) of the Deficit Reduction Act of 2005 (DRA) provides
that the market basket update under the inpatient prospective payment
system (IPPS) will be reduced by 2.0 percentage points for hospitals
that do not participate in quality reporting or do not meet the
requirements associated with reporting the quality measures (for FY
2008, this reduces the update to 1.3 percent).
The market basket, a fixed-weight index, is a
hospital-specific measure of inflation for the costs of goods and
services used by hospitals to furnish inpatient services to Medicare
beneficiaries.
The reporting of hospital quality data under the
RHQDAPU program is part of a program-wide effort to transform Medicare
from being a passive payer of health care services to a prudent
purchaser of high quality care for people with Medicare. The program
was originally authorized under section 501(b) of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and
was launched by CMS in FY 2005 with 10 reportable measures and a 0.4
market basket percentage point reduction for IPPS hospitals that did not
meet program requirements.
In the DRA, Congress reinforced CMS’s efforts by
increasing to 2.0 percentage points the market basket reduction for IPPS
hospitals that do not report on certain quality measures in accordance
with program requirements, and directed CMS to increase the number of
measures. During FY 2007, participating hospitals reported on measures
related to the quality of care they provided to patients with heart
failure, heart disease, and pneumonia, and patients having surgery.
“Medicare payment must encourage reliable,
efficient care, rather than reimbursement based on the quantity of
services provided and resources consumed,” Weems said. “Quality of care
is critical and we must continue our efforts to provide appropriate
measures that are clearly defined and widely agreed upon and which
benefit all consumers of health care.”
CMS claims it has continued to refine the quality
measures since it launched the RHQDAPU program. For FY 2008, hospitals
will be required to report on 27 quality measures, including 24
processes of care measures for discharges on or after January 1, 2007.
The new quality measures for FY 2008 include mortality data, as well as
data collected from patient surveys about their perceptions of the care
they received during an inpatient stay.
“Our beneficiaries pay attention to quality
measures. Indeed, in 2006, our Hospital Compare Web site received 36
million hits, nearly 100,000 a day. This activity demonstrates
consumers are interested in this information – and we have more
information on patient satisfaction coming soon,” added Weems.
CMS implemented the patient satisfaction survey,
known as the Hospital Consumer Assessment of Healthcare Providers and
Systems, or HCAHPS, as part of the RHQDAPU program for FY 2008. The
survey asks about consumer perceptions of the care they have received
during a hospital stay, such as responsiveness of hospital staff,
cleanliness and the overall rating of the hospital.
Beginning with discharges on or after July 1, 2007,
this survey will be one of the quality measures that must be reported by
IPPS hospitals in order to receive the full update.
“Consumers are encouraged to use this information
as a snapshot of the quality of care being delivered,” said Barry M.
Straube, M.D., CMS chief medical officer and director of the Office of
Clinical Standards and Quality. “Consumers should use the information to
have a conversation with their doctors and visit the hospital to better
understand performance of the measures and actions taken to improve
performance.”
Of the nation’s 3,506 acute care hospitals eligible
to participate in the RHQDAPU program in FY 2007, 93 percent
participated and met requirements; 6 percent failed to meet
requirements; and 1 percent chose not to participate. Information
gleaned from the reporting will be made available to the public on the
Medicare beneficiary Web site,
www.medicare.gov, under the “Hospital Compare” topic.
All of the nation’s IPPS hospitals are eligible to
participate in the RHQDAPU program. The program does not, however, apply
to other types of hospitals, or to hospital departments that are not
paid under the IPPS. Hospitals not meeting RHQDAPU program requirements
for FY 2007 may submit a letter to CMS outlining reasons for requesting
reconsideration by November 1, 2007.
There are other comparative databases available at
www.medicare.gov, including Nursing Home Compare, Home Health
Compare, Dialysis Facility Compare and the Medicare Personal Plan
Finder.
Under another DRA provision, hospitals will be
required to report on eight specified conditions when present on
admission, which if included on the hospital claim as a secondary
diagnosis will result in a higher payment for the inpatient stay. The
reporting requirement is effective for discharges on or after October 1,
2007. Beginning with discharges on or after October 1, 2008, hospitals
will no longer receive the higher payment if these conditions are
present as secondary diagnosis at discharge, and were not reported as
present on admission. This provision will give hospitals an incentive
to more thoroughly assess patients on admission, and ensure their safety
during the hospital stay.
In another effort to improve quality of care in
hospital inpatient stays, CMS is implementing the most comprehensive
revision of the diagnosis related groups (DRGs) that serve as the basis
for payment for inpatient services since the inception of the hospital
inpatient prospective payment system in 1983. The new Medicare Severity
DRGs (or MS-DRGs) have been reconfigured to better reflect the severity
of the patient’s condition, so that hospitals will be paid more for
treating the complicated cases.
CMS uses a multi-pronged approach to improve the
quality of care furnished to people with Medicare coverage by supporting
and providing incentives to facilities – and the clinicians and
professionals working in those settings – in their efforts to achieve
superior care. CMS uses:
Ongoing enforcement through state survey agencies
and CMS;
New professional and consumer hospital quality
information on our Web sites,
www.cms.hhs.gov and
www.medicare.gov and at 1-800-MEDICARE;
Demonstration projects to test the effectiveness of
rewards for superior performance on certain measures of quality;
Continual, community-based quality improvement
programs through our Quality Improvement Organizations; and,
Collaboration and partnerships to make full use of
available knowledge and resources.
For more information on Hospital Quality Data for
Annual Payment Update, visit
http://www.cms.hhs.gov/HospitalQualityInits/.
A complete list of the measures to be reported as
part of the FY 2008 RHQDAPU program is below.
QUALITY MEASURES TO
BE REPORTED BY HOSPITALS
IN ORDER TO RECEIVE
THE FULL MARKET BASKET UPDATE IN FY 2008
|
Topic |
Quality Measure |
|
Heart Attack (Acute Myocardial
Infarction) |
|
|
●
Aspirin at arrival * |
|
|
●
Aspirin prescribed at discharge * |
|
|
●
ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker (ARBs)
for left ventricular systolic dysfunction * |
|
|
●
Beta blocker at arrival * |
|
|
●
Beta blocker prescribed at discharge * |
|
|
●
Fibrinolytic (thrombolytic) agent received within 30 minutes
of hospital arrival** |
|
|
●
Percutaneous Coronary Intervention (PCI) received within 120
minutes of hospital arrival** |
|
|
●
Adult smoking cessation advice/counseling** |
|
Heart Failure (HF) |
|
|
●
Left ventricular function assessment * |
|
|
●
ACE inhibitor (ACE-I) or Angiotensin Receptor Blocker (ARBs)
for left ventricular systolic dysfunction * |
|
|
●
Discharge instructions** |
|
|
●
Adult smoking cessation advice/counseling** |
|
Pneumonia (PNE) |
|
|
●
Initial antibiotic received within 4 hours of hospital
arrival * |
|
|
●
Oxygenation assessment * |
|
|
●
Pneumococcal vaccination status * |
|
|
●
Blood culture performed before first antibiotic received in
hospital** |
|
|
●
Adult smoking cessation advice/counseling** |
|
|
●
Appropriate initial antibiotic selection** |
|
|
●
Influenza vaccination status** |
|
Surgical Care Improvement
Project (SCIP) – named SIP for discharges prior to July 2006
(3Q06) |
|
|
●
Prophylactic antibiotic received within 1 hour prior to
surgical incision** |
|
|
●
Prophylactic antibiotics discontinued within 24 hours after
surgery end time** |
|
|
●
SCIP-VTE 1: Venous thromboembolism (VTE) prophylaxis
ordered for surgery patients*** |
|
|
●
SCIP-VTE 2: VTE prophylaxis within 24 hours pre/post
surgery*** |
|
|
●
SCIP Infection 2: Prophylactic antibiotic selection for
surgical patients*** |
|
Mortality Measures (Medicare
patients) |
|
|
●
Acute Myocardial Infarction 30-day mortality Medicare
patients*** |
|
|
●
Heart Failure 30-day mortality Medicare patients*** |
|
Patients’ Experience of Care |
|
|
●
HCAHPS patient survey*** |
*Measure included in 10
measure starter set
**Measure included in 21
measure expanded set
***Measure added in Calendar
Year 2007 OPPS Final Rule
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