CMS adds new measures for future payment determination

In the 2016 IPPS final rule, CMS added three new claims-based measures and one structural measure for the FY 2018 payment determination and subsequent years; it also added three new claims-based measures for the FY 2019 payment determination.

 

The seven new measures are:

All of the new measures are claims based except for Hospital Survey on Patient Safety Culture.

Three of the new clinical episode-based measures--kidney/UTI, cellulitis, and GI hemorrhage--will impact payment in FY 2019, says Shannon Newell, RHIA, CCS, AHIMA-approved ICD-10-CM trainer, director of CDI Quality Initiative for Huff DRG Review in Eads, Tennessee.

 

CMS finalized removal of six topped-out measures:

CMS will retain measures STK-06, STK-08, VTE-1, VTE-2, and VTE-3 as electronic clinical quality measures for the FY 2018 payment determination and subsequent years.

 

The agency did acknowledge that "the intent of a measure is the same whether it is reported via chart-abstraction or electronically, the submission modes are not the same and measure rates may be different."

 

It also removed measures:

 

The HVBP Program adjusts payments to hospitals for inpatient services based on their performance on an announced set of measures.

 

CMS finalized removal of IMM-2 (Influenza Immunization) because it determined the measure was topped out.

 

CMS is also removing AMI-7a (Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival) because few hospitals have the minimum number of cases necessary to report the measure.

 

Because CMS finalized the removal of these two measures from the Clinical Care-Process subdomain, the agency finalized its proposal to move PC-01 (Elective Delivery) from Clinical Care-Process to the Safety domain. CMS will eliminate the Critical Care-Process subdomain and rename the Clinical Care-Outcomes subdomain as simply the Clinical Care domain.

 

The agency also adopted a new measure for FY 2018 reporting: 3-Item Care Transition Measure (CTM-3).

 

The Hospital-Associated Infection measures will expand the population in FY 2019. The Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) measures will include selected ward (non-ICU) locations.

 

CMS defines selected ward (non-ICU) locations as adult or pediatric medical, surgical, and medical/surgical wards.

 

CMS also finalized the addition of Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease Hospitalization beginning in FY 2021.

Analyze and address performance improvement opportunities for associated new and/or modified measures, Newell says.

 

"For claims-based measures, it is important to address documentation and coding vulnerabilities that impact the population included in the measure, referred to as the 'cohort,' as well as the risk-adjustment variables which impact the mortality, complication, and efficiency measures," she adds.

 

Revisit the definitions used to capture "severe sepsis," which disqualifies discharges from inclusion in the pneumonia measure, Newell says.

 

Hospitals and CDI departments should also analyze and address data quality opportunities to improve Patient Safety Indicator (PSI) 90 measure performance under Agency for Healthcare Research and Quality (AHRQ) QI version 4.5a, which will be used in FY 2017.

 

AHRQ has rolled out more updated PSI versions that have not been adopted by CMS. "These updated version measure specifications significantly impact which discharges are included in each PSI, as well as how discharges are risk adjusted," Newell says. "Hospitals interested in integrating clinical and financial performance pertinent to CMS quality programs need to make sure they are using the correct version of the measure specifications." 

 

CMS finalized the 24-month period from July 1, 2013, through June 30, 2015, as the time frame for Domain 1 measure (AHRQ PSI-90 Composite measure).

 

CMS decreased the Domain 1 weight from 25% to 15% and increased the Domain 2 weight from 75% to 85% for FY 2017.

 

CMS also finalized an expansion of data for CLABSI and CAUTI measures. The agency will include data from pediatric and adult medical ward, surgical ward, and medical/surgical ward locations, in addition to data from adult and pediatric ICU locations for the CLABSI and CAUTI measures, beginning in FY 2018.

 

As part of the discussion of the HACRP, CMS acknowledged comments about quality measures included in both the HVBP Program and the HACRP.

 

CMS noted that the overlapping measures "cover topics of critical importance to quality improvement in the inpatient hospital setting and to patient safety."

 

The agency also stated that the two programs have different purposes and policy goals.

 

CMS noted that the National Quality Forum (NQF) has not yet completed maintenance review of the PSI 90 measure.

 

"CMS clarified in the final rule that PSI 90 has not lost NQF endorsement, which is in fact not required for measure adoption into the HVBP [Program]," Newell says.

 

The NQF is considering expanding this measure from eight PSIs to 11 PSIs. The prior version of PSI 90 remains adopted. CMS will provide notification of any future refinements to this measure upon completion of NQF maintenance review.

 

"CDI departments should analyze and address data quality opportunities to improve PSI 90 measure performance under AHRQ QI version 4.5a," Newell says.

 

Newell also encourages CDI programs to assess performance for the three PSIs targeted for potential inclusion in the CMS PSI 90 measure. 

 

Editor’s note: This article was originally published in the August issue of Briefings on Coding Compliance Strategies. Email your questions to editor Steven Andrews at sandrews@hcpro.com.