Proposed 2009 OPPS: Quality push continues
ED managers have the opportunity to increase reimbursements under the proposed 2009 rule for the Outpatient Prospective Payment System (OPPS), but they also will come under greater scrutiny by the Centers for Medicare & Medicaid Services (CMS) for the quality of their care. For example, CMS proposed to implement a data validation approach starting with January 2009 encounters in which it would randomly select 800 reporting hospitals and validate the accuracy of reported data by selecting 50 records per selected hospital on an annual basis.
| ED Quality Measures
Source: National Quality Forum, Washington, DC. |
"They will be auditing your records to validate whether the quality data you have reported is actually supported in the data," explains Dennis Beck, MD, FACEP, CEO of Beacon Medical Services, an emergency medicine practice management company in Denver, and chair of the quality and performance committee of the American College of Emergency Physicians (ACEP). "It will require coordination [of the ED manager] with the coders, or whoever is doing the entry of quality reporting, to make sure they can only report what is documented in the ED."
In the past, the increase in Medicare's payment for outpatient services has not been specifically tied to the quality of health care. Now, however, the law requires that the annual outpatient prospective payment system (OPPS) inflation update be reduced by two percentage points for hospitals that do not meet quality reporting requirements. To receive the full OPPS payment update for services furnished in calendar year 2009, hospitals must report quality data from calendar year 2008.
CMS also has added an ED quality measure endorsed by the National Quality Forum (NQF) — median time from ED arrival to ED departure for discharged ED patients — to a list of 18 new quality measures that have been released for public comment. However, those 18 measures are proposed for implementation in fiscal year 2011, which means they would likely apply to encounters beginning January 2010.
"We think this is an important measure, but it's only one," notes John Moorhead, MD, professor of emergency medicine at Oregon Health & Science University, Portland, past president of ACEP, and co-chair of the NQF steering committee that made the recommendation. "We want people to start reporting their throughput times, which would then give us a basis on which to report to the public."
As for what that median time should be, Moorhead says, "we don't know what that median [throughput] time is; it is a reporting measure, not a benchmark."
This is just one of 10 measures Moorhead's committee has recommended to NQF. (See chart, left, for the complete list). The rest of the measures have not yet been endorsed by NQF, notes Dell M. Conyers, senior program director for NQF. "They are out for comment, and then our members will vote, so there are a few more layers until final endorsement."
Any final endorsement would come in November 2008, he says. "We could endorse all of them, none of them, or somewhere in between," he notes.
ED managers have the opportunity to increase reimbursements under the proposed 2009 rule for the Outpatient Prospective Payment System (OPPS), but they also will come under greater scrutiny by the Centers for Medicare & Medicaid Services (CMS) for the quality of their care.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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