CMS Launches "Transforming Clinical Practice Initiative"

CMS has announced its newest innovative delivery reform program, called the “Transforming Clinical Practice Initiative,” which will provide up to $840 million over four years to help clinicians share, adapt, and develop quality improvement strategies. CMS intends to make awards for the following two types of systems:

  • Practice Transformation Networks are peer-based learning networks designed to help clinicians develop core competencies specific to practice transformation. CMS is seeking applicants that have pre-existing relationships with multiple clinician practices that include data sharing capabilities (e.g., health systems; regional extension centers; quality improvement organizations; large group practices; regional/state-based health collaboratives; and hospital systems).
  • Support and Alignment Networks will promote workforce development through organizations that use tools such as continuing medical education, maintenance of certification, and core competency development to help ensure sustainability of these efforts. Applicants could include medical professional associations, specialty societies, and organizations that generate evidence-based clinical practice guidelines, support efforts to reduce unnecessary testing and procedures, and effectively incorporate safety and patient/family engagement.

Applicants are encouraged to submit a letter of intent by November 20, 2014, and applications are due by January 6, 2015. CMS anticipates announcing awards in spring/summer 2015.

CMS Releases Medicare Advantage/Drug Plan Quality Data, Enforcement Statistics

CMS has posted the 2015 Medicare Star Ratings for Medicare Advantage (MA) and Medicare Part D prescription drug plans (PDPs). According to a CMS fact sheet, there are increases in the number of Medicare beneficiaries in high-performing MA plans and PDPs for 2015, while CMS notes “dramatic improvement” among plans that had received the low performing icon in 2014. CMS also is interested in receiving information from the public regarding potential data differences in MA and Part D quality measurements for dual-eligible versus non-dual-eligible enrollees. Information is due November 3, 2014. Finally, CMS has released the MA and PDP annual audit and enforcement report for 2013. According to the report, CMS imposed 43 CMPs totaling almost $8.4 million on 39 different organizations and 5 cases of immediate suspension of enrollment and marketing activities for issues identified in 2012 and 2013. Most violations cited in enforcement actions related to inappropriate delays or denials of access to health services and medications for enrollees.

CMS Open Door Forum on IRF Quality Reporting Program (Oct. 29)

CMS is hosting a conference call for inpatient rehabilitation facility (IRF) providers regarding the IRF Quality Reporting Program on October 29, 2014. Specifically, CMS will discuss data collection and submission information for outcome measures related to hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and Clostridium difficile infection (CDI), which IRF providers are required to report to CMS beginning January 1, 2015.

CMS to Revise Five Star Quality Rating System for Nursing Homes

CMS has announced that it will make a series of improvements to the Nursing Home Five Star Quality Rating System, including additional quality measures, new data verification processes, and a revised quality scoring methodology. Among other things:

  • CMS will add a new quality measure on antipsychotic medication use starting January 2015, and include claims-based data on re-hospitalization and community discharge rates in the future.
  • CMS and states will implement focused survey inspections for a sample of nursing homes to verify staffing and quality measure information, effective January 2015.
  • CMS will implement a quarterly electronic reporting system that is auditable back to payrolls to verify staffing information and allow for the calculation of staffing-related quality measures.
  • CMS will strengthen requirements to ensure that states maintain a user-friendly website and complete timely, accurate nursing home inspections for inclusion in the rating system.
  • CMS will revise the methodology used to calculate each facility’s quality measure rating in 2015.

CMS Call on Hospital Compare/HCAHPS Star Ratings (Oct. 8)

On October 8, 2014, CMS is hosting a call to discuss its plans to begin publicly reporting Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Ratings on the Hospital Compare website. CMS intends to begin the HCAHPS Star Ratings reporting in April 2015.

CMS Call: How to Avoid 2016 Negative Payment Adjustments under Medicare Quality Reporting Programs

On September 17, 2014, CMS is hosting a call on negative payment adjustments that could apply under several Medicare quality reporting programs in 2016.  Specifically, the call will offer instructions on how eligible professionals and group practices can avoid the 2016 Physician Quality Reporting System negative payment adjustment, satisfy the clinical quality measure component of the EHR Incentive Program, and avoid the automatic CY 2016 Value-Based Modifier downward payment adjustment.

CMS Finalizes Medicare IPPS/LTCH PPS Update for FY 2015

On August 22, 2014, CMS is publishing a final rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2015, which begins October 1, 2014.  The following are highlights of the sweeping regulations.

With regard to the IPPS, the final rule provides for a 1.4% operating payment rate update for hospitals that submit quality data and are meaningful Electronic Health Record (EHR) users. This update reflects a 2.9% market basket update, adjusted by a -0.5 percentage point multi-factor productivity (MFP) cut and an additional -0.2 percentage point cut (both mandated by the Affordable Care Act), with an additional -0.8 percentage point documentation and coding recoupment adjustment. Despite the positive operating rate update, total IPPS payments (capital and operating payments) are projected to decrease by about $756 million in FY 2015 as a result of reductions under the Hospital Readmissions Reduction Program, the Hospital Acquired Condition (HAC) Reduction Program, Medicare disproportionate share hospital (DSH) payment changes, and other policy changes. Moreover, CMS is revising the labor market areas used in the wage index, but adopting a 1-year transition policy for FY 2015 to mitigate potential negative payment impacts.

The rule makes numerous changes to hospital quality programs, including updating measures aligning certain reporting requirements in both the EHR Incentive Program and the Hospital Inpatient Quality Reporting Program. In addition, the rule modifies the Hospital Value-Based Purchasing Program to increase the applicable percent reduction (the portion of Medicare payments available to fund incentive payments under the program) to 1.5% of the base operating DRG payment amounts to all participating hospitals, which will generate approximately $1.4 billion for value-based incentive payments in FY 2015. In addition, the rule increases the maximum reduction in payments under the Hospital Readmissions Reduction program from 2% to 3%. The rule also implements the ACA HAC Reduction Program, which will reduce by 1% Medicare inpatient payments to hospitals with the highest rates of certain conditions that are reasonably preventable when those conditions are acquired after the beneficiary has been admitted to the hospital for a different condition.

Other IPPS policies in the rule address, among other things, the low-volume hospital payment adjustment and the Medicare Dependent Hospital program, graduate medical education funding, and critical access hospital payments. CMS also reminds hospitals of their statutory obligation to establish and make public a list of its standard charges for items and services.

With regard to the LTCH PPS, CMS estimates that estimated payments per discharge will rise by 0.8% in FY 2015, and total payments will increase by 1.1%, or approximately $62 million. This increase is attributable to several factors, including a 2.2% rate update, which is based on a market basket update of 2.9% adjusted by a -0.5 percentage point MPF adjustment and an additional adjustment of -0.2 percentage points. CMS is also applying a “one-time” prospective budget neutrality adjustment to standard federal rate of approximately -1.3% under the last year of a three-year phase-in. For 2015, the standard federal rate will be $40,240.51 (compared to the FY 2014 rate of $40,607.31), and the fixed-loss amount for high cost outlier cases will be $14,972 (compared to the FY 2014 amount of $13,314). Note that LTCHs are subject to a 2.0 percentage point reduction for failure to submit required quality data for FY 2015.

The final rule also eliminates the 5 percent readmissions policy for LTCH patients discharged on or after October 1, 2014. Under this policy readmissions from co-located providers in excess of 5 percent are paid a single LTCH payment instead of separate admission and readmission payments. CMS indicated that this policy is not needed in light of recent statutory changes establishing clinical criteria for standard LTCH-PPS payments that will be implemented for discharges beginning on or after October 1, 2015. CMS did not finalize an earlier proposal to change the fixed-day threshold under the LTCH PPS greater than 3-day interrupted stay policy.

Separately, CMS has published corrections to the August 19, 2013 FY 2014 IPPS/LTCH final rule to restore regulatory text related to the administration of pneumococcal vaccines that had been inadvertently removed.

CMS Issues Proposed CY 2015 Medicare OPPS/ASC Rule

On July 14, 2014, the Centers for Medicare & Medicaid Services (CMS) published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2015. The following are highlights of this major rulemaking:

  • OPPS rates would increase by 2.1% compared to 2014 levels, although rate changes for individual Ambulatory Payment Classifications (APCs) vary. This update reflects a 2.7% market basket increase, which is partially offset by a 0.4% multifactor productivity (MFP) adjustment and an additional 0.2% reduction, both of which were mandated by the Affordable Care Act (ACA). Hospitals that fail to meet the Hospital Outpatient Quality Reporting (OQR) Program reporting requirements are subject to an additional reduction of 2.0%. The actual update for individual procedures can vary based on changes in relative weights and other policies in the proposed rule. Overall, CMS expects to make $800 million in additional payments for OPPS services furnished in CY 2015 under the rule.
  • CMS proposes expanding its packaging policy adopted in the 2014 final rule. Beginning in CY 2015, CMS proposes conditional packaging of all ancillary services when they are integral, ancillary, supportive, dependent, or adjunctive to a primary service (except for preventive, psychiatry, and drug administration services). The services proposed to be packaged under this policy are services assigned to APCs with a geometric mean cost of $100 or less. CMS proposes to make separate payment for these ancillary services when they are furnished by themselves. CMS expects to update and expand this policy in future years. CMS also proposes packaging all add-on codes, but it would allow certain combinations of primary service codes and especially costly add-on codes representing a more costly, complex variation of a procedure to trigger a complexity adjustment.
  • The proposed rule would implement, with revisions, a policy discussed in the final 2014 rule to replace existing device-dependent APCs in CY 2015. In short, CMS would make a single payment for all related or adjunctive hospital services provided to a patient in the furnishing of certain device dependent services, with certain exceptions. Under this policy, the comprehensive APC payment would include all outpatient services, including diagnostic procedures, laboratory tests and other diagnostic tests, and treatments that assist in the delivery of the primary procedure; visits and evaluations performed in association with the procedure; services and supplies used during the service; outpatient department services delivered by therapists as part of the comprehensive service; durable medical equipment (DME), as well as prosthetic and orthotic items and supplies when provided as part of the outpatient service; and any other outpatient components reported by HCPCS codes that are provided during the comprehensive service (except for certain services including mammography services, ambulance services, brachytherapy seeds, and pass-through drugs and devices). CMS proposes refining its 2014 policy to establish a total of 28 comprehensive-APCs for 2015 versus the 29 comprehensive APCs described in the 2014 final rule.
  • CMS proposes to continue to calculate which the OPPS relative payment weights using distinct cost-to-charge ratios for cardiac catheterization, CT scan, MRI, and implantable medical devices.
  • Under the proposed rule, the threshold for separate payment for outpatient drugs in 2015 would be a cost per day that exceeds $90, the same threshold as in 2014.
  • The proposed rule would revise OQR measures and modify OQR Program validation, review, and corrections provisions.
  • CMS proposes collecting data on services furnished in off-campus provider-based departments beginning in 2015. Hospitals and physicians would report a modifier for services furnished in an off-campus provider-based department on both hospital and physician claims. This information ultimately is intended to be used to improve the accuracy of Medicare physician fee schedule (MPFS) practice expense payments for services furnished in off-campus provider-based departments.
  • The proposed rule would revise the expansion exception process for physician-owned hospitals under the rural provider and hospital ownership exceptions to the physician self-referral law. Specifically, CMS proposes to permit physician-owned hospitals to use additional data sources to demonstrate eligibility for an expansion exception as a “high Medicaid facility.”
  • For CY 2015, CMS proposes an ASC prospective payment system update of 1.2%, reflecting a CPI-U update of 1.7%, offset by a 0.5% MFP adjustment. Payment updates for individual procedures vary. ASCs that do not meet quality reporting requirements are subject to a 2% payment reduction. CMS proposes adding 10 procedures to the ASC list of covered surgical procedures and refining the ASC quality program.
  • CMS proposes to require a physician certification only for long-stay cases (defined as 20 days or more) and outlier cases. An admission order would continue to be required for all admissions.
  • CMS proposes establishing a process to recover overpayments that result from the submission of erroneous payment data by a Medicare Advantage (MA) organization or Part D prescription drug plan sponsor if the plan fails to correct the data upon CMS request, with an appeals process for MA organizations and Part D sponsors.

CMS will accept comments on the proposed rule until September 2, 2014.

CMS Proposes ESRD PPS Update for CY 2015

On July 11, 2014, CMS published a proposed rule to update the Medicare end-stage renal disease (ESRD) PPS for CY 2015, which CMS anticipates would increase total payments to all ESRD facilities by 0.3% compared to CY 2014. While CMS projects that the ESRD market basket update, as adjusted for MFP, would have been 1.6%, the “Protecting Access to Medicare Act of 2014” (PAMA) sets the CY 2015 ESRD payment update at 0.0 percent. After applying a proposed wage index budget-neutrality adjustment factor, CMS estimates that the CY 2015 ESRD PPS base rate would be $239.33 under the proposed rule. The proposed rule also would, among other things: rebase the ESRD bundled market basket using 2012 data; update outlier Medicare Allowable Payment (MAP) and fixed dollar loss amounts (which will increase payments to ESRD facilities for beneficiaries requiring higher resource utilization); revise the market basket measures; update the labor -related share value with a two-year transition; clarify the eligibility criteria for the low volume payment adjustment ; and implement a PAMA provision providing that payment for ESRD-related oral-only drugs will not be made under the ESRD PPS prior to January 1, 2024. CMS also proposes updates to the ESRD Quality Incentive Program (QIP) for payment years 2017 and 2018. Finally, the proposed rule would make significant changes to Medicare reimbursement policy for DME, prosthetics, orthotics, and supplies (DMEPOS). CMS will accept comments on the proposed rule until September 2, 2014.

CMS Proposes 0.3% Cut in Medicare Home Health PPS Rates for CY 2015

Today CMS released its proposed rule to update Medicare home health prospective payment system (HH PPS) rates for CY 2015. CMS estimates that the rule would reduce Medicare payments to home health agencies by approximately $58 million (-0.3%) in 2015 compared to 2014 levels. Specifically, while CMS anticipates a 2.2% home health payment update percentage ($427 million increase), the increase would be more than offset by implementation of the second year of a four-year phase-in of the rebasing adjustments to the HH PPS rates, which would result in a -2.5% adjustment ($485 million decrease).

The proposed rule also includes a number of policy proposals, including: simplification of the face-to-face encounter documentation requirements and clarification of when such documentation is required; changes to the HH PPS case-mix weights; revisions to the home health quality reporting program; simplification of therapy reassessment timeframes; a revision to the Speech-Language Pathology personnel conditions of participation; and limitations on the reviewability of CMS’s decision to impose a civil monetary penalty for noncompliance with federal participation requirements. Finally, the rule discusses insulin injections under the HH PPS and the delay in implementation of ICD-10-CM, and it solicits comments on the HHA value-based purchasing.

The official version of the rule is scheduled to be published on July 7, 2014. CMS will accept comments until September 2, 2014.

CMS Plans Series of Calls this Month on Medicare Dialysis Quality Programs

On July 10, 2014, CMS is hosting a national provider call to discuss the new Five Star Rating system that will be added to Dialysis Facility Compare (DFC) in October 2014. Among other things, the call will address the methodology used to calculate the ratings and how to access and preview the ratings.  In addition, CMS is holding a provider call on July 16 on the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP), a pay-for-performance initiative that ties a facility's quality scores to payment during a payment year (PY). The call will focus on the preliminary ESRD QIP PY 2015 Performance Score Report, which previews how well facilities scored on the relevant quality measures.  Finally, a July 23 call will focus on PY 2017 and PY 2018 ESRD QIP provisions in the upcoming ESRD prospective payment system proposed rule.

CMS Plans Medicare Quality "Star" Ratings for Hospitals, Dialysis Facilities, Home Health

On June 18, 2014, CMS announced in a blog posting that it is planning to add a “Five Star” quality rating system to the Hospital Compare, Dialysis Facility Compare, and Home Health Compare websites on The agency will start making the new quality ratings available later this year and into early 2015. CMS already maintains star ratings on its Nursing Home Compare and Physician Compare sites.

CMS Finalizes ACA Exchange, Insurance Market Standards for 2015 and Beyond

On May 27, 2014, CMS published a final rule updating ACA Affordable Insurance Exchange and insurance market standards beginning in 2015. Among other things, the rule addresses standards related to: standardized consumer notices regarding insurance product discontinuation and renewal; Qualified Health Plan (QHP) quality data reporting to support quality ratings for plans on the insurance marketplace beginning in 2016; non-discrimination standards; employee choice in the Small Business Health Options Program (SHOP); enforcement remedies in federally-facilitated exchanges; the imposition of civil money penalties for providing false or fraudulent information to the Exchange and for improperly using or disclosing information; updated standards for “Navigators” and other consumer assistance programs; increases the risk corridor calculation ceiling on allowable administrative costs and the floor on profits by 2% “to account for uncertainty and changes in the market prior to and during benefit year 2015”; and modifies the allocation of reinsurance collections if those collections do not meet projections. The rule also provides for an expedited prescription drug exceptions process based on exigent circumstances (defined as when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee’s life, health, or ability to regain maximum function, or when an enrollee is undergoing a current course of treatment using a non-formulary drug). Under this provision, health plans must make coverage determinations within 24 hours after receiving the request; once an exception is granted, issuers must continue to provide the drug throughout the duration of the exigency. CMS states that it will continue to monitor this issue to consider whether it should propose additional standards.

CMS Proposes FY 2015 Update to Inpatient Psychiatric Facility PPS

On May 6, 2014, CMS published a proposed rule that would update prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs) for FY 2015. Under the proposed rule, the federal per diem base rate would be increased by 2.0%, reflecting a market basket increase of 2.7%, offset by a 0.3 percentage point reduction and a productivity adjustment reduction of 0.4 percentage points (both of which were mandated by the ACA). CMS also anticipates a 0.1 percent overall increase in IPF outlier payments from the update to the outlier fixed-dollar loss threshold amount. When all FY 2015 proposed payment and policy changes are considered, CMS estimates that total payments to IPFs would increase by 2.1% compared to FY 2014 payments (approximately $100 million). The proposed rule also would, among other things, establish a new methodology for updating the cost of living adjustment (COLA) and expand quality measures under the IPF Quality Reporting Program. In the proposed rule, CMS also discusses its intention to propose an IPF-specific market basket for FY 2016, and the agency addresses various coding changes. CMS will accept comments on the proposed rule until June 30, 2014.

CMS Proposes FY 2015 Update to Medicare IRF PPS

On May 7, 2014, CMS published its proposed rule to update Medicare payment policies under the inpatient rehabilitation facility (IRF) PPS for FY 2015. Under the proposed rule, rates would be updated by a 2.1% increase factor, which reflects a 2.7% market basket update, reduced by a -0.4% MFP adjustment and a -0.2 percentage point adjustment mandated by the ACA). Taking into account an additional 0.1% increase to aggregate payments resulting from an update to the outlier threshold, CMS expects IRF PPS rates to rise on average by 2.2% (or $160 million in aggregate) compared to FY 2014 levels. CMS proposes to freeze facility-level adjustment factors (e.g., adjustments for Low-Income Percentage, teaching status, and location in a rural area, if applicable) for FY 2015 and all subsequent years at FY 2014 levels while the effects of FY 2014 changes are evaluated. Among other things, the proposed rule would: revise the list of impairment group codes that presumptively meet the “60 percent rule” compliance criteria; add items to the IRF patient assessment instrument (PAI); and revise the IRF Quality Reporting Program to update measures and add a data accuracy validation policy. The proposed rule also discusses the transition from ICD-9-CM to ICD-10-CM for use on Medicare claims and IRF–PAI submissions (although this transition has been put on hold temporarily as a result of the Protecting Access to Medicare Act of 2014). CMS will accept comments on the proposed rule until June 30, 2014.

CMS Releases Proposed Medicare Inpatient PPS/LTCH Update for FY 2015

Late on April 30, 2014, CMS released the advance text of its proposed rule to update the Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2015.

With regard to IPPS hospitals, the rule would provide for a 1.3% operating payment rate update, which reflects a 2.7% market basket update, adjusted by a -0.4 percentage point multi-factor productivity cut and an additional -0.2 percentage point cut (both mandated by the Affordable Care Act), with an additional -0.8 percentage point documentation and coding recoupment adjustment. Updates to IPPS hospitals are also subject to several other quality-related adjustments under the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, the Hospital-Acquired Condition (HAC) Reduction Program, the Hospital Inpatient Quality Reporting Program, and the Electronic Health Records Incentive Program. Despite the positive operating rate update, total IPPS payments (capital and operating payments) are projected to decrease by about $241 million in FY 2015 as a result of reductions under the Hospital Readmissions Reduction Program, the HAC Reduction Program, Medicare disproportionate share hospital payment changes, the expiration of certain statutory provisions that temporarily increased payments to hospitals, and other policy changes included in the sweeping 1688-page rule.

With regard to LTCHs, CMS estimates that the rule would increase LTCH PPS payments by 0.8%, or approximately $44 million. This increase would result from a 2.1% update to the standard federal rate (reflecting a 2.7% market basket update offset by a 0.4 percentage point multi-factor productivity adjustment and a -0.2 percentage point reduction under the ACA), a -1.3% budget neutrality adjustment, and a projected decrease in estimated high cost outlier payments. LTCHs are subject to a 2.0 percentage point reduction for failure to submit required quality data for FY 2015. Moreover, other policies in the proposed rule, including implementation of statutory provisions in the Pathway for SGR Reform Act of 2013 and the Protecting Access to Medicare Act of 2014 (including reinstating moratoria on full implementation of the “25 percent threshold” payment adjustment and on the development of new LTCHs and LTCH satellite facilities and additional LTCH beds) and a proposed expansion of the interrupted stay policy, among others, would reduce LTCH PPS payments by approximately $14 million, for a total net increase of approximately $30 million.

The official version of the proposed rule will be published on May 15, 2014. CMS will accept comments on the proposed rule until June 30, 2014. The final rule will be published by August 1, 2014, and will apply generally to discharges occurring on or after October 1, 2014.

CMS Posts First Medicare Inpatient Psychiatric Facility Quality Data

On April 17, 2014, CMS announced that it making inpatient psychiatric facility quality data available as part of the Hospital Compare website. Specifically, CMS is now posting data for the period of October 1, 2012 through March 31, 2013 regarding the following measures: Hours of Physical Restraint Use; Hours of Seclusion Use; Post-Discharge Continuing Care Plan Created; and Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge. Next year, CMS also expects to post data regarding the measures “Patients Discharged on Multiple Antipsychotic Medications” and “Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification.”

GAO Offers Recommendations for Improvements to CMS Physician Feedback Efforts

A recent GAO report looked at how private health care entities provide performance data to physicians, and how such practices could be used to improve CMS efforts to provide feedback to providers. The GAO determined that the nine health insurers and statewide collaboratives it reviewed typically employ multiple benchmarks (e.g., peer group averages or past performance), while CMS only compares results to the national average rates of all physician groups that submitted data on any given measure. The GAO observes that CMS’s approach precludes physicians from viewing their performance in fuller context. The private entities also sent reports more than once a year, in contrast to CMS annual reports that may limit physicians' opportunity to make improvements in advance of their annual payment adjustments. The GAO suggests that as CMS implements and refines its physician feedback and Value Modifier programs, it should consider comparing physicians' performance against additional benchmarks, such as state or regional averages, and disseminating performance reports more frequently. The report is entitled  “Medicare: Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMS's Efforts.” 

CMS Issues Call for PQRS Quality Measures

On May 1, 2014, CMS will begin accepting recommendations for potential Physician Quality Reporting System (PQRS) quality measures for 2016 and future rulemaking years. Quality measure proposals also will be considered for use in other physician quality programs, including the Value Based Modifier, Physician Compare, and the Medicare Shared Savings Program.

CMS Announces System to Collect Hospice Care Data Beginning July 1, 2014

On April 8, 2014, CMS published a notice announcing that it is establishing a new “system of records” to collect data to support the Hospice Quality Reporting Program. The new “Hospice Item Set” (HIS) is a standardized mechanism for abstracting data from a patient’s medical record to confirm that the appropriate assessments were made and concerns were addressed for the following domains of care: (1) Pain; (2) Respiratory Status; (3) Medications; (4) Patient Preferences; and (5) Beliefs & Values. The notice is effective on May 8, 2014, and comments will be accepted until that date. Beginning July 1, 2014, hospices will be required to submit two HIS records for each patient admitted to their organization: an HIS-Admission record and an HIS-Discharge record. 

Older Entries

February 18, 2014 — FTC Workshop on Health Care Competition (March 20-21)

February 11, 2014 — CMS to Host "Physician Compare Town Hall Meeting" (Feb. 24)

January 6, 2014 — CMS Call: ESRD Quality Incentive Program Payments (Jan. 15)

November 25, 2013 — Medicare Home Health PPS Rates Cut 1.05% Under Final 2014 Rule

November 13, 2013 — CMS Call on IRF Quality Reporting Requirements (Nov. 14)

November 11, 2013 — CMS Special Open Door Forum on LTCH Quality Reporting (Nov. 21)

September 12, 2013 — CMS Call on 2015 Value-Based Payment Modifier (Sept. 24)

August 28, 2013 — CMS Finalizes FY 2014 Medicare IPPS, LTCH Rates

August 28, 2013 — CMS Issues Final FY 2014 Medicare Inpatient Rehabilitation Facility (IRF) Rule

August 27, 2013 — CMS Finalizes Hospice Policies, Rates for FY 2014

July 5, 2013 — Medicare Home Health PPS Rates to Drop under Proposed CY 2014 Rule

June 11, 2013 — CMS Invites Comments on Proposed PPS-Exempt Cancer Hospital Quality Measures

May 14, 2013 — CMS Proposes Medicare IPPS and LTCH PPS Rates/Policies for FY 2014

May 13, 2013 — CMS Proposes Hospice Payment Policies for FY 2014

May 13, 2013 — CMS Proposes Updated FY 2014 Medicare Payments and Other Policies for IRFs

May 1, 2013 — CMS Proposed Changes to Medicare LTCH Payment Rates and Policies for FY 2014

April 11, 2013 — Updated House SGR Reform Proposal

March 8, 2013 — CMS Call: ESRD Quality Incentive Program (March 13)

March 8, 2013 — National Provider Call: Hospital Value-Based Purchasing FY 2015 Overview (March 14)

January 30, 2013 — GAO Offers Recommendations for Medicare Physician Value Modifier Program

January 14, 2013 — Hospital Readiness for Electronic Quality Reporting

December 17, 2012 — Interim Rule Revises EHR Certification Criteria, Incentive Program Specifications

November 29, 2012 — CMS Requests Comments on ACA Exchange Health Plan Quality Management

November 29, 2012 — ACA Medicare Data Sharing Provision Implementation Proceeds

November 16, 2012 — CMS Finalizes OPPS, ASC Rates and Policies for 2013

November 16, 2012 — CMS Adopts 2013 ESRD PPS Update, Bad Debt Reimbursement Cuts

November 16, 2012 — CMS Adopts 2013 Medicare Home Health PPS Rates, Update to Hospice Quality Program

October 31, 2012 — CMS Posts Specifications for Electronic Clinical Quality Measures (eCQMs)

October 15, 2012 — CMS Calls on IRF, LTCH Quality Reporting (Oct. 18)

September 24, 2012 — CMS to Host ASC Quality Reporting Webinar (Sept. 26)

August 20, 2012 — CMS Issues Final Medicare Inpatient Hospital Rates/Policies for FY 2013

August 20, 2012 — CMS Adopts LTCH PPS Payment, Policy Changes for FY 2013

August 16, 2012 — CMS Forum on LTCH Quality Reporting (Aug. 30)

July 27, 2012 — CMS Publishes FY 2013 Medicare Hospice Wage Index/Rate Update Notice, Comorbidity Diagnosis Reminder, Quality Update

July 25, 2012 — CMS Forum: Improving Care for Medicare Beneficiaries with ESRD (July 31)

July 20, 2012 — CMS Schedules Calls on IRF Quality Reporting Program

July 19, 2012 — CMS Issues Proposed OPPS, ASC Policies for 2013

May 14, 2012 — CMS Proposes Medicare Inpatient Hospital Rates/Policies for FY 2013

April 2, 2012 — GAO Examines CMS Nursing Home Quality Rating System

February 22, 2012 — Physician Value-Based Payment Modifier Program: Experience from Private Sector Physician Pay-for-Performance Programs (Feb. 29)

February 10, 2012 — CMS Call on Hospital Value-Based Purchasing Program Performance Reports (Feb. 28)

January 5, 2012 — Final Medicaid Core Quality Measures

December 13, 2011 — CMS Seeks Early Input on Future Quality & Efficiency Measures

December 12, 2011 — CMS Call: Payment Standardization and Risk Adjustment for the Medicare Physician Feedback & Value Modifier Programs (Dec. 21)

November 22, 2011 — Hospital Value Based Purchasing National Provider Call

November 21, 2011 — CMS Call on IRF Quality Reporting (Nov. 29)

November 14, 2011 — CMS Issues Final Medicare Physician Fee Schedule Rule for 2012

November 14, 2011 — CMS Finalizes CY 2012 OPPS/ASC Rates, Policy Changes

November 14, 2011 — CMS Adopts Home Health PPS Rate Cut for 2012

November 14, 2011 — CMS Updates End-Stage Renal Disease (ESRD) PPS for 2012

October 28, 2011 — GAO Report Examines CMS Oversight of Long-Term Care Hospitals

September 29, 2011 — CMS Accepting Comments on LTCH Quality Measures

September 29, 2011 — CMS Seeks Comments on Hospice Quality Reporting Forms

September 20, 2011 — CMS Accepting Suggestions for Future PQRS Measures (Due Oct. 7)

September 19, 2011 — CMS Call on Long-Term Care Hospital (LTCH) Quality Reporting Program (Sept. 21)

September 8, 2011 — CMS Call on Changes to Medicare Electronic Prescribing (eRx) Incentive Program (Sept. 13)

August 16, 2011 — CMS Issues Final Medicare Inpatient Hospital PPS Rule for FY 2012

August 16, 2011 — CMS Issues Final FY 2012 Medicare Long Term Acute Care Hospital PPS Rule

August 16, 2011 — GAO Assesses Challenges with CMS Physician Feedback Program

August 16, 2011 — GAO Examines Information for Policymakers on Health Care Quality/Value

August 1, 2011 — CMS Releases Final FY 2012 Hospice Wage Index Rule

August 1, 2011 — CMS Finalizes FY 2012 Inpatient Rehabilitation Facility (IRF) PPS Policies

July 27, 2011 — ESRD Quality Incentive Program Special Open Door Forum (Aug. 4)

July 19, 2011 — CMS Issues Proposed CY 2012 Physician Fee Schedule Rule

July 18, 2011 — CMS Proposes CY 2012 OPPS/ASC Rates, Policy Changes

July 18, 2011 — CMS Proposes CY 2012 Changes to End-Stage Renal Disease (ESRD) PPS

July 15, 2011 — CMS Special Open Door Forum on FY 2013 Hospital Value-Based Purchasing Program (July 27)

July 13, 2011 — CMS call on Physician Quality Reporting System/E-Prescribing Incentive Program (July 26)

June 14, 2011 — CMS Proposes ACA Medicare Claims Data Sharing Rule

June 8, 2011 — CMS Physician Quality Reporting System & E-Prescribing Incentive Program Provider Teleconference (June 21)

May 31, 2011 — Federal Agencies Outline Regulatory Review Plans

May 11, 2011 — CMS Call on Medicare/Medicaid EHR Incentive Programs: Understanding Meaningful Use (May 19)

May 11, 2011 — CMS Forum on 2011 Physician Quality Reporting System and Electronic Prescribing Incentive Programs: ICD-10 Conversion (May 26)

May 11, 2011 — 2011 Physician Quality Reporting System & Electronic Prescribing Incentive Program National Provider Call (May 17)

April 29, 2011 — CMS Proposes Medicare Inpatient Hospital/LTCH Payment Policies for FY 2012

April 29, 2011 — CMS Finalizes ACA Hospital Value-Based Purchasing Program

April 29, 2011 — CMS Issues Proposed FY 2012 Inpatient Rehabilitation Facility (IRF) PPS Rule

April 29, 2011 — CMS Releases FY 2012 Hospice Wage Index Proposed Rule, Notice of Ruling on Hospice Cap Challenges

April 29, 2011 — CMS Releases 2009 Quality Reporting Data

March 19, 2011 — CMS call on Physician Quality Reporting/E-Prescribing for Beginners (March 22)

March 19, 2011 — CMS Forum on Hospital Quality Reporting/HAC Measures (March 21)

March 2, 2011 — 2011 Physician Quality Reporting System/E- Prescribing Incentive Call (March 8)

February 24, 2011 — CMS to Hold Call on Medicaid Quality Measures (Feb. 28, 2011)

January 13, 2011 — CMS Proposes Hospital Value Based Purchasing Program

January 13, 2011 — ESRD Quality Incentive Program Final Rule

January 13, 2011 — HHS Seeks Comments on Draft Medicaid Quality Measures

December 13, 2010 — HIT Quality Measures Workgroup Comment Opportunity

December 6, 2010 — CMS Meeting on Developing New Imaging Efficiency Measures (Jan. 31, 2011)

December 6, 2010 — CMS Open Door Forum on LTCH, IRF, and Hospice Quality Measures (Dec. 16)

December 6, 2010 — Physician Quality Reporting/E-Prescribing Incentive Call (Dec. 15)

October 20, 2010 — CMS Hospital Value-Based Purchasing Program Special Forum (Oct. 26)

October 13, 2010 — CMS to Host PQRI/E-RX Call (Oct. 19)

October 6, 2010 — CMS Call on ASC Value-Based Purchasing (Oct. 14, 2010)

September 24, 2010 — CMS Town Hall Meeting on ACA Physician Compare Web Site Mandate (Oct. 27)

August 31, 2010 — Listening Session on ACA Provision on Use of Medicare Data for Performance Measurement (Sept. 20, 2010)

August 16, 2010 — CMS Forum on ESRD Quality Incentive Program (Aug. 24, 2010)

August 13, 2010 — Final FY 2011 Medicare Inpatient Hospital, LTCH Rates

August 11, 2010 — 2010 PQRI/E-Rx National Provider Call (Aug. 17, 2010)

June 7, 2010 — CMS PQRI/E-Prescribing Provider Call (June 22)

April 16, 2010 — 2009 National Healthcare Quality & Disparities Reports