CMS doc outlines HAI prevention efforts
Tells Congress 'CMS is focused on patient safety'
Patrick Conway, MD, director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS) recently cited a plethora of programs designed to reduce health care associated infections (HAIs).
Testifying at a September 24, 2013 HAI prevention hearing of the Senate Committee on Health, Education, Labor, and Pensions, Conway said "The Affordable Care Act (ACA) and other laws are now enabling CMS to support better health and promote quality improvement and greater value while creating an environment that fosters innovation."
Some of the CMS initiatives and activities to reduce HAIs cited in Conway's testimony are summarized as follows:
Hospital Acquired Conditions (HACs)
Since 2008, Medicare payment policy has further encouraged hospitals to identify ways to prevent certain HACs or conditions that are not present on admission. For these designated conditions, while Medicare pays hospitals the standard rates for the original admission, we no longer pay hospitals for the additional costs associated with the care and treatment of these HACs. In 2012, CMS added additional HACs to the list of conditions that would warrant CMS eliminating additional payments. CMS clinical quality experts have worked closely with public health and infectious disease experts from CDC to identify and select additional preventable HACs, including HAIs to add to this list.
In addition, the ACA established the HAC Reduction Program to further reduce HACs and improve patient quality. CMS will begin implementing this program starting in Fiscal Year (FY) 2015 with the performance period starting this year. Under the HAC Reduction Program, hospitals in the lowest-performing quartile with respect to the overall rate of certain HACs will see their payments reduced by one percent, providing an incentive for those hospitals to reduce the burden of HACs in their facilities.
Hospital Value-Based Purchasing (VBP)
CMS has implemented VBP programs to strengthen payment incentives to improve the quality of hospital care furnished to traditional fee-for-service Medicare beneficiaries. As required by the ACA, beginning with October 2012 discharges, CMS began adjusting Medicare payments to most hospitals for inpatient acute care services based on how well they performed on a series of quality measures. The VBP program was developed in a manner that incorporated significant stakeholder feedback.
The quality measures used in the program are consistent with evidence-based clinical practices for the provision of high-quality care. Hospitals are scored on improvement as well as achievement on a variety of quality measures. The higher a hospital's total performance score during a performance period, the higher the hospital's value-based incentive payment will be for a subsequent fiscal year.
For fiscal year 2014, the VBP program will redistribute an estimated $1.1 billion to hospitals based on their quality performance. We recently added the CLABSI measure beginning with the FY 2015 program, and we finalized the addition of the CAUTI and SSI measures to the program for the FY 2016 program. In the future, CMS expects to add new measures to the program that focus on patient health outcomes, cost reduction, and HAIs that significantly impact Medicare beneficiaries and reflect substantial quality of care variation among hospitals.
Hospital Inpatient Quality Reporting (IQR)
The IQR program gives hospitals a financial incentive to report the quality of their inpatient services by tying the reporting of designated quality measure data to their ability to be paid the full amount of the annual update to the Medicare inpatient payment rate. CMS has adopted a number of HAI measures for the program, and some of this data is collected on CMS' behalf by the CDC through that agency's National Healthcare Safety Network (NHSN). The CDC has developed the HAI measures that are used in the IQR program, and provides hospitals with additional analytic tools that enable them to assess their rates of performance and identify where additional efforts are needed. The HAI measures that hospitals currently report to the NHSN as part of the hospital IQR program are CLABSIs, CAUTIs, SSIs, Clostridium difficile, and MRSA data.
Hospital Readmissions Reduction Program (HHRP)
The ACA also established the HHRP, which reduces Medicare payments to hospitals that have excess readmissions beginning in October 2012. Currently, we measure the readmissions rates for three very common and expensive conditions for Medicare beneficiaries — heart attack, heart failure, and pneumonia. We recently finalized expanding the readmissions program with measures for two more common conditions — chronic obstructive pulmonary disease and knee and hip replacements. These measures will be added to the program in FY 2015.
Transparency for Consumers through Hospital Compare and HealthCare.gov
Clear, understandable information that is easy to access helps consumers make informed decisions about their health care, and gives them an important role in reducing and preventing HAIs. CMS created the Hospital Compare Website to better inform health care consumers about a hospital's quality of care. This tool, which includes CDC's NHSN HAI measure results and data, shows a hospital's performance on a wide variety of quality measures, including certain measures of health care infections. In the coming years, additional measures will be added to the Hospital Compare website, making this an even richer source of information for consumers.
Partnership for Patients (PFP)
The nationwide PFP initiative aims to avert millions of preventable HACs and reduce hospital readmissions over three years, while providing savings to Medicare and Medicaid by reducing complications and readmissions during the transition from one care setting to another. Over 3,700 hospitals, as well as physicians and nurses' organizations, consumer groups, employers, and other major stakeholders, have pledged to help achieve the partnership's goals. The PFP's 10 safety areas of focus are: CAUTIs, CLABSIs, SSIs, ventilator-associated pneumonia, adverse drug events, injuries from falls and immobility, obstetrical adverse events including early elective deliveries, pressure ulcers, venous thromboembolism, and hospital readmissions.
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