Medicare Compliance & Reimbursement

Submitting quality data is the key.

Hospitals need to participate in CMS' quality reporting initiative if they don't want to miss out on all the Medicare reimbursement the government is making available to them.

Congress has approved higher pay for hospitals that submit quality performance data - and the Centers for Medicare & Medicaid Services Jan 28 started laying the groundwork for what they must do to qualify for the added reimbursement.

"Public reporting of quality measures is a mainstay of the administration's Quality Reporting Initiative," says CMS Acting Administrator Dennis Smith. "Today's notice is especially important for those hospitals that have not yet begun to work with us in submitting and reporting their data, so that they ensure that they receive their full monetary update for 2005."

"Aligning payment with superior quality is a major focus of this agency, and today's guidance is one important piece of that," Smith adds.

The data must reflect patient discharges during the most recent quarter available for all patients - not just Medicare recipients - on a set of 10 quality measures, which were selected based on three serious disease areas that usually indicate a hospital stay. 
 
The measures are:

Heart attack (Acute Myocardial Infarction) 
 1. Was aspirin given to the patient when upon arrival at the hospital?
 2. Was aspirin prescribed when the patient was discharged from the hospital?
 3. Was a beta-blocker given to the patient upon arrival at the hospital?
 4. Was a beta-blocker prescribed when the patient was discharged?
 5. Was an ACE Inhibitor given for the patient with heart failure? Heart Failure
 6. Did the patient get an assessment of his or her heart function?
 7. Was an ACE Inhibitor given to the patient? Pneumonia
 8. Was an antibiotic given to the patient in a timely way?
 9. Had a patient received a Pneumococcal vaccination?
 10. Was the patient's oxygen level assessed?
           
Hospitals need to sign up with your quality improvement organizations' data warehouse by June 1, 2004 and submit the required data there by July 1, 2004. If they are late in getting everything in, but have at least started data submission by July 1, they'll still be allowed a 30-day grace period to complete it.

For more information, go to: www.cms.hhs.gov/quality/hospital.

Lesson Learned: If hospitals haven't made plans to submit quality performance data, they could miss out on their share of Medicare reimbursement next year.