On March 10-11, 2010, CMS is convening a Technical Expert Panel (TEP) to assist in the development of new ESRD quality measures. Six Clinical TEPs will evaluate evidence related to the development of new measures related to: Anemia Management; Mineral Metabolism; Vascular Access Infection Rate; Pediatric Adequacy; Pediatric Anemia; and Fluid Weight Management. CMS is accepting nominations for the TEP until February 17, 2010.
CMS has published a notice soliciting comments on an initial set of children's health care quality measures for voluntary use by state Medicaid and Children’s Health Insurance Program (CHIP) and health insurance issuers and managed care entities that contract with these programs, and providers of Medicaid and CHIP services. The notice also seeks input on how to facilitate the voluntary use of the children's health care quality measures. The comment deadline is March 1, 2010.
A recent OIG report, “Adverse Events in Hospitals: Public Disclosure of Information about Events,” focuses on policies and practices associated with the public disclosure of hospital adverse event information, including mechanisms for protecting patient privacy. In the OIG review of 17 state adverse event reporting systems, eight Patient Safety Organizations overseen by AHRQ, and CMS Medicare claims data, the OIG found only limited public disclosure of information about adverse events (defined as harm experienced by a patient as a result of medical care). The OIG notes, however, that seven state systems disclosed more extensive information than others (e.g., analysis of the causes of adverse events, guidance for reducing future occurrences, and information about improvements made by hospitals), which can serve as models for other entities.
On February 2, 2010, CMS is hosting a “Listening Session” to solicit feedback on potential 2011 PQRI quality measures. The session also will address PQRI program design issues, including possible reporting mechanisms, reporting periods, criteria for satisfactory reporting, the group practice reporting option, and public reporting of 2011 PQRI data. The registration deadline for the session is January 22, 2010.
CMS is hosting a national provider conference call on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing Incentive Program (eRx) on January 12, 2010. Registration closes at 1:30 p.m. EST on January 9, 2010.
On January 14, 2010, CMS is hosting a special open door forum on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (eRx) Incentive Programs. The call will focus on a new reporting option available for the 2010 PQRI and eRx Incentive Program, known as the Group Practice Reporting Option (GPRO). Note that group practices interested in participating in the GPRO must submit a self-nomination letter to CMS by January 31, 2010.
CMS has announced another opportunity for the public to submit quality measure suggestions for consideration for use in the 2011 Physician Quality Reporting Initiative (PQRI). Suggestions must be received by December 16, 2009. The public will have a comment opportunity once CMS announces the measures it will propose for the 2011 PQRI.
On December 10, 2009, CMS is hosting a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). The registration deadline is December 9.
The Centers for Medicare & Medicaid Services (CMS) has released its final rule updating the Medicare physician fee schedule (MPFS) for calendar year (CY) 2010. Most notably, the final rule calls for a 21.2% across-the-board cut in MPFS paymentsfor 2010 due to the statutory sustainable growth rate (SGR) formula (CMS had forecast a 21.5% cut in the proposed rule). For 2010, the SGR formula results in a conversion factor of $28.4061, compared to the 2009 conversion factor of $36.0666. [NOTE: CMS subsequently published a notice correcting the conversion factor; the new conversion factor is $28.3895]. As noted above, Congressional leaders are seeking a legislative solution to block the pending cut, but the outcome of these reform efforts are not certain at this time. CMS did exercise its administrative authority to remove drugs from the definition of “physicians’ services” for purposes of the SGR formula, which CMS expects will reduce the number of future years in which physicians are projected to experience a negative update under the SGR formula, but which does not impact 2010 rates. The sweeping rule affects a wide range of other Medicare policies, as discussed after the jump.
The official version of the rule is scheduled to be published in the Federal Register on November 25, 2009. CMS will accept comments on certain provisions of the final rule until December 29, 2009. Specifically, CMS is accepting comments on the following issues: interim RVUs for selected codes, the physician self-referral designated health services, services for consideration for the Five-Year Review of work RVUs, and whether additional guidance is needed regarding CMS’s policy regarding services provided under arrangement.
CMS has issued its final rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and ambulatory surgical center (ASC) payment system for 2010. The official version of the rule is scheduled to be published in the Federal Register on November 20, 2009. With regard to the HOPPS update, CMS estimates that the rule will increase HOPPS rates by 1.9% compared to total spending in CY 2009. This reflects a 2.1% market basket increase (reduced by 2.0 percentage points for hospitals that do not report quality data), adjusted for changes in the pass-through estimate, outlier payments, and wage index payments. Other major HOPPS and ASC provisions are outlined after the jump.
Other major provisions of the HOPPS final rule include the following:
With regard to ASC services, the final rule provides a 1.2% inflation update to the conversion factor. CMS also is adding 26 surgical procedures to the list of procedures covered when performed in an ASC. In addition, the rule: designates six procedures as office-based procedures (subject to payment at the lesser of the national office practice expense payment to the physician or the national standard ASC rate); temporarily designates an additional 16 procedures as office-based for 2010; and updates the list of device-intensive procedures and covered ancillary services.
CMS is accepting comments on limited provisions of the rule until December 29, 2009. These provisions pertain to: payment classifications for certain HCPCS codes; treatment of plasma protein fraction for HOPPS payment purposes; alternative coding for hospital clinic visits for new and established patients; potentially extending the direct supervision requirements for hospital-based partial hospitalization program services to such services in community mental health centers; and potentially establishing direct physician supervision requirements for ASC services.
On July 1, 2009, the Centers for Medicare & Medicaid Services (CMS) released the advance text of its proposed rule with comment period updating the Medicare physician fee schedule (MPFS) for calendar year (CY) 2010. Most notably, the proposed rule calls for a 21.5% across-the-board reduction in physician fee schedule payments under the statutory sustainable growth rate (SGR) formula. Over the past several years, Congress has repeatedly stepped in to block cuts triggered by the SGR formula, and such efforts are underway as part of broader health reform legislation, although the level of relief, if any, that may be provided is uncertain at this time. In the proposed rule, CMS has exercised its regulatory authority to remove drugs from the definition of “physicians’ services” for purposes of the SGR formula. CMS notes that spending on physician-administered drugs has risen faster than all other MPFS services, contributing significantly to the large projected reductions in future MPFS updates under the SGR formula. While this would not mitigate the projected negative 21.5% update for 2010, it would reduce the number of years in which negative updates are expected. In other policy areas the rule would, among many other things:
The official version of the rule will be published in the Federal Register on July 13, 2009, and comments will be accepted until August 31, 2009.
On July 1, 2009, CMS released its proposed rule updating the Medicare hospital outpatient prospective payment system (HOPPS) and the ambulatory surgical center (ASC) payment system for 2010. With regard to the HOPPS update, CMS estimates that the rule would increase HOPPS rates by 1.9% compared to total spending in CY 2009. This reflects a 2.1% market basket increase (reduced for hospitals that do not report quality data, as discussed below), adjusted for changes in the pass-through estimate and estimated outlier payments and the expiration of special wage index payments. Other proposals affecting HOPPS payments and other policies include the following:
With regard to ASC services, the proposed rule would provide a 0.6% inflation update to the conversion factor. CMS also proposes to add 28 surgical procedures to the list of procedures covered when performed in an ASC (including two new codes and 26 procedures that previously were excluded). In addition, the rule would newly designate six procedures as office-based procedures (subject to payment at the lesser of the national office practice expense payment to the physician or the national standard ASC rate), and it would update the list of device-intensive procedures and covered ancillary services. The official version of the rule is scheduled to be published in the Federal Register on July 20, 2009. Comments on the proposed rule are due August 31, 2009.
On June 17, 2009, CMS is hosting a national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). Under the PQRI, eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished during the reporting period, January 1, 2009 - December 31, 2009, will earn an incentive payment of 2.0 percent of their total allowed charges for Physician Fee Schedule covered professional services furnished during the period. Topics on the call will include: how to access the PQRI help desk; review of the incentive payments and feedback reports timeline; and an update on the upcoming decisions registries for 2009. Registration for the call is required.
CMS it is holding a Special Open Door Forum conference call on May 20 to discuss the development and implementation of facility-level hospital outpatient imaging efficiency measures.
Senate Finance Committee Chairman Max Baucus and Ranking Member Chuck Grassley released a lengthy policy paper on April 28, 2009 discussing options for reducing health care costs and improving quality in the health care delivery system, including significant Medicare payment reform proposals. Key areas addressed in the paper include the following:
The the deadline for public comments is May 15, 2009. The document is the first of three sets of potential option papers, each covering a different topic area that members will discuss before a bipartisan “Chairman’s Mark” on comprehensive health care reform is developed. Policy option papers on increasing health care coverage and financing health care reform will be released following future roundtable discussions on those topics. Note that the Finance Committee held its roundtable discussion on access to health care coverage on May 5, 2009, so an options paper on that topic should be available in the near future. In addition, on May 12, the Senate Finance Committee is holding its third roundtable discussion, this one focusing on financing comprehensive health care reform.
CMS has released the 2009 Data Submission Specifications for use in the 2009 Physician Quality Reporting Initiative (PQRI) Electronic Health Record test.
CMS is accepting suggestions for possible reporting options for use in the 2010 Physician Quality Reporting Initiative (PQRI). All suggestions must be received by April 17, 2009.
The OIG has released a report from an event it cosponsored with the Health Care Compliance Association (HCCA) in November 2008 on “Driving for Quality in Acute Care: A Board of Directors Dashboard," the sixth roundtable collaboration between OIG and HCCA. Participants at the government-industry roundtable included representatives from hospital systems, trade associations, and government. The meeting focused on how hospital boards of directors can use information dashboards, or scorecards, as a tool to promote quality of care in their institutions. The discussions included information on best practices for tracking measures of quality, safety, customer satisfaction, and financial and employee performance. Participants also offered suggestions for increasing accountability for quality outcomes and stressed the importance of promoting transparency of quality of care information. The full report is available here.
On April 22, 2009, CMS will host another national provider conference call on the 2009 Physician Quality Reporting Initiative (PQRI). Eligible professionals who meet the criteria for satisfactory submission of quality measures data for services furnished in 2009 will earn an incentive payment of 2.0 percent of their total allowed charges for services covered under the Medicare Physician Fee Schedule in 2009. The registration deadline is April 21.
On January 29, 2009, the HELP Committee is holding a hearing entitled "Crossing the Quality Chasm in Health Reform."
On January 15, 2009, CMS announced three final national coverage determinations (NCDs) to deny Medicare coverage of certain types of serious, preventable surgical errors. Specifically, CMS will no longer cover: (1) wrong surgical or other invasive procedures performed on a patient; (2) surgical or other invasive procedures performed on the wrong body part; or (3) surgical or other invasive procedures performed on the wrong patient. The coverage policy complements CMS’s hospital-acquired conditions payment policy, under which Medicare will not make higher payments to hospitals for care associated with certain reasonably-preventable conditions unless the conditions were reported as present on admission. The NCDs are effective immediately, although implementation guidance will be issued at a later date.
On January 16, 2009, the Bush Administration released a variety of information summarizing CMS efforts to tie Medicare fee-for-service payments to quality and value of care. The documents include quality measure, resource use measurement, and value-based purchasing “roadmaps.”
The HHS Office of Inspector General (OIG) has issued a report on the top management and performance challenges facing the HHS. Key areas identified by the OIG include: Medicare Part D oversight (including drug pricing and rebates, fraud and abuse safeguards, and access to accurate information); Medicare integrity (including DME fraud and competitive bidding); Medicare Advantage; Medicaid and State Children’s Health Insurance program integrity (including prescription drug fraud and pharmacy reimbursement); quality of care (including pay-for-performance, “never events,” and transparency of ownership and performance); emergency preparedness and response; oversight of food, drugs, and medical devices (including food safety and security, drug and medical device safety, and transparency of provider financial interests); grants management; integrity of information systems and the implementation of health information technology; and ethics program oversight and enforcement.
On January 8, 2009, CMS announced that more than 3,000 hospitals – or 99.3 percent of participating hospitals -- will receive the full Medicare payment update for calendar year (CY) 2009 as part of the new Hospital Outpatient Quality Data Reporting Program. The reporting program was mandated by the Tax Relief and Health Care Act of 2006, and applies to all hospitals paid under the hospital outpatient prospective payment system (OPPS). Under this program, eligible hospitals that successfully report outpatient quality data receive the full market basket update; those that do not receive an update that is reduced by 2.0 percentage points.
The HHS Office of Inspector General (OIG) has issued three reports on adverse events in hospitals, defined by the OIG as harm to a patient as a result of medical care. The first report, “Adverse Events in Hospitals: Overview of Key Issues,” identifies a number of areas integral to understanding the landscape of adverse events in hospitals, including the difficulty of measuring the incidence of adverse events, the importance of nonpayment policies for adverse events, barriers to adverse event reporting, legal concerns associated with public disclosure; and slow adoption of adverse event prevention recommendations. A second report, “Adverse Events in Hospitals: State Reporting Systems,” found that 26 states operated adverse event reporting systems as of January 2008. State strategies include legal protections to prevent improper disclosure, monetary penalties for failing to report, and feedback to hospitals about reported events. While specific reportable events and reporting criteria vary, most states use reported data in similar ways to hold individual hospitals accountable for their patient care performance and to promote learning and prevent adverse events. Finally, in “Adverse Events in Hospitals: Case Study of Incidence Among Medicare Beneficiaries in Two Selected Counties,” the OIG found that 13% of hospitalized Medicare beneficiaries in two selected counties experienced one of the four most serious categories of adverse events. The OIG notes that while “the results of this review are not nationally representative, the extent of adverse events and temporary harm found in this case study substantiates concerns about the incidence of adverse events in hospitals and the importance of safety initiatives to reduce occurrences.” The OIG will continue his work in this area.
CMS is holding a provider conference call December 16, 2008 to discuss the final results of the 2007 Physician Quality Reporting Initiative (PQRI).
On December 11, 2008, CMS is hosting its second “special open door forum” on electronic prescribing (e-prescribing), at which CMS will provide an overview of Part D e-prescribing standards and discuss e-prescribing resources, incentives and measures. In a related development, CMS has announced the specifications for the e-prescribing measure, including the requirements for a qualified e-prescribing system, which will be used to determine whether an eligible professional is a successful e-prescriber and may qualify for a 2% incentive payment for the 2009 reporting period.
CMS has released a document entitled “Medicare’s Practical Guide to the E-Prescribing Incentive Program,” which explains the e-prescribing incentive program, how eligible professionals can participate, and how to choose a qualified e-prescribing system.
On November 19, 2008, Senate Finance Committee Chairman Max Baucus and Ranking Member Chuck Grassley released a discussion draft of legislation that would establish a value-based purchasing program for Medicare inpatient hospital care. Under the plan, Medicare payments would be linked to hospital performance -- rather than just reporting -- on certain quality measures. The initial performance measures focus on treatment of heart attacks, heart failure, pneumonia, and surgical care. The budget-neutral plan would be phased in over five years, beginning in FY 2012, with full implementation beginning in FY 2016. Comments on the draft will be accepted through December 15, 2008.
CMS is hosting a Special Open Door Forum November 19 on electronic prescribing under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). At the forum, CMS staff will present information on the following topics: Overview of Part D E-Prescribing Standards, E-Prescribing Resources, E-Prescribing Incentives and E-Prescribing Measures. The forum will take place from 3:30pm-5pm eastern time. The call-in number is 1-800-837-1935; reference conference ID 71918357.
On November 3, 2008, CMS published a notice updating the 60-day national episode rates and the national per-visit amounts under the Medicare home health prospective payment system (HH PPS), effective January 1, 2009. The notice includes a 2.9 percent home health market basket increase, but this increase is largely offset by a 2.75 percent reduction to the HH PPS rates to account for the changes in case-mix that are unrelated to patient’s health status (the second year of a four-year phase-in) and an adjustment to the wage index for 2009. CMS estimates that overall Medicare home health payments will increase by a total of $30 million in CY 2009. As mandated by the Deficit Reduction Act of 2005, if a home health agency does not submit quality data, the home health market basket percentage increase will be reduced 2 percentage points. The required quality measures for meeting the submission requirements for CY 2009 are the same as those used for CY 2008.
CMS has announced that because of the impact of recent hurricanes, it will grant a data submission waiver to IPPS hospitals in selected counties of Louisiana and Texas that are unable to meet the submission of quality data requirements for the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) for FY 2010. Hospitals that have questions about this process should contact their local Quality Improvement Organization.
The GAO has issued a report entitled “Health-Care-Associated (HAI) Infections in Hospitals: An Overview of State Reporting Programs and Individual Hospital Initiatives to Reduce Certain Infections." The report looks at (1) the design and implementation of state HAI public reporting systems, (2) hospital initiatives to reduce MRSA infections, and (3) the experience of certain early-adopting hospitals in overcoming challenges to implement such initiatives.
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