CMS to add outpatient quality measures to OPPS
Agency shifts to link reimbursement to quality
In its proposed rule for the Outpatient Prospective Payment System, issued July 3, 2008, the Centers for Medicare & Medicaid Services (CMS) continued its efforts to tie reimbursement to quality of services, adding four new outpatient quality measures that hospitals must report on and asking for public comments on an additional 18 measures being considered for future years.
The purpose of the proposed rule is to build on efforts to transform Medicare into a "prudent purchaser of health care services, paying based on quality of care and not just quantity of services," says CMS acting administrator Kerry Weems.
"As more and more health care services shift from the inpatient to the outpatient setting, we are committed to working with hospitals to ensure that people with Medicare have access to high-quality care in an appropriate setting," he says.
CMS is accepting public comment on the proposed rule until Sept. 2 and will issue the final rule by Nov. 1.
Hospitals already have been required to report on seven quality measures including:
- five measures of standards of care in the ED for acute myocardial infarction (AMI) patients transferred to other facilities for care;
- two outpatient surgical care improvement measures.
CMS is proposing to add four measures of imaging efficiency for the 2010 update. The agency also is seeking comment on 18 additional quality measures under consideration for quality reporting requirements in future years. These include:
- ED throughput;
- cancer care;
- screening for fall risk management of certain clinical conditions;
- depression;
- osteoporosis;
- asthma;
- community-acquired pneumonia.
Hospitals that have not been submitting data on those measures for services furnished on or after April 1, 2009, will receive 2% less than the market basket inflation update for services furnished in calendar year 2009, which begins Jan. 1.
In addition, CMS also proposes to reduce the beneficiary copayment amount for services furnished in hospitals that have not met their reporting requirements so that beneficiaries share in the reduction of payments to the hospital.
The proposed rule also asks for comments on options for modifying payments to hospitals for treating conditions that are generally preventable if the provider follows established guidelines. CMS already is implementing a similar policy for inpatient stays, and after Oct. 2, hospitals no longer will receive a higher rate for treating some preventable conditions if they are acquired during a hospital stay.
This is the first time that payment for outpatient services has been tied to quality reporting.
The outpatient quality measures are part of CMS' value-based purchasing initiative, which links payment to quality, rather than just the delivery of services. CMS is required by the Deficit Reduction Act of 2005 to have a plan for value-based purchasing in place by 2009.
In the proposed rule, CMS announced plans for instituting a data validation measuring system for quality data beginning in January 2009. As part of the program, CMS would randomly select 800 hospitals and validate their reported data by analyzing 50 records at the selected hospitals each year.
In its proposed rule for the Outpatient Prospective Payment System, issued July 3, 2008, the Centers for Medicare & Medicaid Services (CMS) continued its efforts to tie reimbursement to quality of services, adding four new outpatient quality measures that hospitals must report on and asking for public comments on an additional 18 measures being considered for future years.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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