NEWS YOU CAN USE: Payment Reduction in Store for Hospitals Falling Short on Quality Measures

CMS penalizes hospitals for not participating in quality reporting

 • Quality measures expanded for 2007
 If your facility reported data on the quality of care you deliver, you may be looking forward to a 2 percent annual payment boost as a reward. But the Centers for Medicare & Medicaid Services plans to slap those unlucky 171 facilities that either didn’t participate or failed the submission requirements with a 2 percent reduction in their annual Medicare fee schedule update for fiscal year 2007 " a startling change from last year’s 0.4 percent reduction.
 Only 28 of the 3,490 eligible acute-care hospitals in the United States chose not to participate in reporting quality-of-care data to CMS, the agency said in a Sept. 29 announcement. About 143 hospitals “failed the submission requirements,” CMS said.
 These statistics come from CMS’ initiatives to provide “transparency in information for consumers on quality performance measures linked to payments hospitals receive for treating Medicare beneficiaries,”  the agency says. And hospitals are seeing stiffer penalties for not participating in quality-reporting initiatives or not meeting the requirements.
Consider an Appeal
 But for those hospitals that are faced with the steep 2 percent reduction in Medicare reimbursement for falling short on quality measures, there is a light at the end of the tunnel, CMS says. “Hospitals not meeting the quality data requirements for FY 2007 may exercise its right to appeal and submit a letter to CMS outlining its reasons for requesting reconsideration by no later than Nov. 1, 2006,” the agency says.
 The quality reporting initiative stems from the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. And although CMS calls hospitals’ participation “voluntary,” the agency has found that 99 percent of hospitals are choosing to report quality data rather than face the
2 percent reduction in Medicare reimbursement.
 The agency hopes that patients will use the quality data to evaluate care choices and that hospitals will use it to improve performance, CMS administrator Mark McClellan said in a statement. “This unprecedented, consistent information on the quality of hospital care is possible because of the collaboration of hospitals, consumers, insurers, and employers working together to achieve a more transparent healthcare system,” he adds.
 The 10-measure starter set has expanded to 21 measures for 2007, which address heart attack, heart failure, pneumonia and surgical care " the most common reasons for hospital stays for Medicare beneficiaries, CMS says. CMS wants to expand the set of measures even more for FY 2008, according to the Outpatient Prospective Payment System proposed rule, which was open for comments until Oct. 10.
 The additional quality measures would include more surgical care measures, mortality measures and a patient satisfaction survey.
 To view the proposed rule, go [...]

- Published on 2006-11-09