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Quality, readmissions, and hospital-acquired conditions among the performance measures in CMS FY 2013 hospital inpatient payment final rule

Premier Communications

From the Premier Safety Institute®
Gina Pugliese, R.N., M.S., editor

Safety Share®

CMS FY 2013 IPPS performance measures

Quality, readmissions, and hospital-acquired conditions among performance measures in final rule


On August 1, the Centers for Medicare & Medicaid Services (CMS) issued its fiscal year (FY) 2013 Medicare inpatient prospective payment system
(PPS)/long-term care hospital (LTCH) PPS final rule. In the rule, CMS projects that Medicare operating payments to acute care hospitals for discharges
occurring in FY 2013 would increase by 2.3 percent. This includes, among other adjustments, a restoration to the base rates of 2.9 percent to ensure that a
prior documentation and coding adjustment does not continue to cut hospital payments into the future. Also included are several new provisions related to
quality measure reporting and payment updates based on hospitals’ performance.

Hospital value-based purchasing (VBP) program and reduced payment for readmissions

Beginning in FY 2013, the Affordable Care Act (ACA) reduces by up to 1 percent inpatient payments based on each hospital’s readmission rates for acute
myocardial infarction, chronic heart failure and pneumonia. The readmission payment adjustment will be applied to claims beginning October 1, 2012. It also
establishes a Medicare value-based purchasing program that ties 1 percent of payments to a hospital’s performance on a set of quality measures. For the
value-based purchasing program in 2015, CMS is finalizing its proposal to add three new measures, including the Medicare Spending per Beneficiary measure
and two new outcomes measures – Central Line-Associated Blood Stream Infection (CLABSI) measure and the Patient Safety Indicator (PSI-90) composite

Hospital-acquired condition (HAC) payment policy
For the HAC payment for FY 2013, CMS is adding Surgical Site Infection (SSI) Following Cardiac Implantable Electronic Device (CIED) Procedures and
Pneumothorax with Venous Catheterization to the HAC payment provision for FY 2013. SSI following CIED will be added to the existing SSI category,
rather than exist as its own category as CMS proposed. CMS is also adding diagnosis codes 999.32 (Bloodstream infection due to central venous catheter) and
999.33 (Local infection due to central venous catheter) to the existing Vascular Catheter-Associated Infection HAC category for FY 2013.

Hospital inpatient quality reporting (IQR) proposed measures

For FY 2015 payment determination, under the hospital inpatient quality reporting (IQR) program, CMS is reducing the total number of measures from the
current 72 measures to 59 measures.
See attached summary of performance measures for FY 2014-2016. This includes:

three claims-based readmissions measures:

  • Hospital-Level 30-Day All-Cause Risk-Standardized Readmission Rate (RSRR) Following Elective Total Hip Arthroplasty (THA) and Total Knee Arthroplasty;
  • Hip/Knee Risk Complication S: for Hip/Knee complication Hip/Knee Complication: Hospital-Level Risk-Standardized Complication Rate (RSCR) Following
    Elective Primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty; and
  • Hospital-Wide Readmission.

a three-part care transition measure to HCAPHS survey along with two questions for the “about you section” – admission through the emergency department and
overall emotional and mental health

one chart abstracted measure on Elective Delivery

(For FY 2016) one structural measure (Use of Safe Surgery Checklist) for a total of 60 measures

17 measures:

    • One chart abstracted, SCIP-VTE-1, as the measures process is included in SCIP-VTE-2 “Surgery patients who received appropriate VTE prophylaxis within 24
      hours of pre/post surgery”;
    • Eight hospital-acquired conditions;
    • Five Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs); and
    • Three AHRQ Inpatient Quality Indicators (IQIs).

Healthcare Personnel Influenza Vaccination

Although payment determination for healthcare personnel influenza vaccination measure will not begin until FY 2015, data submission via CDC’s NHSN begins January 1, 2013. The CDC’s NHSN reporting module will be available on September 14 and the training materials, forms and instructions will be available on September 7.

2013 Final Rule-

watch recording recording from
Premier’s AdvisorLive® webinar, held on August 16, 2012, to hear Danielle Lloyd, Premier’s vice president of policy, review the provisions of the
final rule




Safety Institute




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