CMS Hospital Quality Data Updates

on Tuesday, 05 March 2019. All News Items | Quality | Documentation | Coding

Readmissions, Hospital-Acquired Conditions, and Hospital Star Ratings

Last Thursday February 28th, CMS announced updates to hospital performance data on Hospital Compare  and data.medicare.gov. CMS Administrator Seema Verma noted “the Hospital Compare website and Star Ratings System are valuable consumer tools that provide helpful and important information on the safety and quality of our nation’s hospitals…These decision-making tools offer greater transparency on hospital performance for a wide variety of users – patients, caregivers, families, and the broader healthcare industry.”

Hospital Readmissions

It’s been seven years since CMS began reducing Medicare payments for Inpatient Prospective Payment System Hospitals (IPPS) hospitals with excess readmissions for specific conditions through the Hospital Readmission Reduction Program (HRRP). Current specific conditions includes:

  • Heart Attack (AMI),
  • Heart Failure (HF),
  • Pneumonia (PNA),
  • Chronic Obstructive Pulmonary Disease (COPD),
  • Hip/Knee Replacement (THA/TKA), and
  • Coronary Artery Bypass Graft Surgery (CABG).

For FY 2019, the government estimates hospitals will lose $566 million. You can read more about the penalties in a September 26, 2108 Kaiser Health News (KHN) Article by Jordan Rau.

Hospital-Acquired Condition (HAC) Reduction Program

The HAC Reduction Program began in FY 2015 and is a Medicare pay-for-performance program supporting the CMS effort to link Medicare payments to quality in the inpatient hospital setting. Hospitals ranking in the worst-performing quartile with respect to risk-adjusted HAC quality measures are subject to a 1 percent payment reduction.

Per a March 1, 2019 Kaiser Health News (KHN) article by Jordan Rau, “eight hundred hospitals will be paid less by Medicare this year because of high rates of infection and patient injuries.” This is the highest number of hospitals penalized in a given year since the program was implemented. Utilizing data from the 2019 spreadsheet available in the KHN article, the following tables trend the number of hospitals penalized in the Jurisdiction J MAC.

Also of note is the number of hospitals in each of these states that were penalized for the first time for 2019:

  • 6 Alabama Hospitals
  • 3 Georgia Hospitals, and
  • 4 Tennessee Hospitals.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

 

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Hospital Star Ratings

Per CMS, the Star Ratings drive systematic improvements in care and safety as hospitals strive to achieve and maintain high ratings. In the February 28th announcement, CMS also posted potential changes to the Hospital Star Ratings for public comment. CMS is “specifically asking for comments about the potential methodological updates and topics in active re-evaluation.” You can find more information on the CMS Public Comment Page. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/PC-Currently-Accepting-Comments.html#a0228

The public comment period closes on March 29, 2019.

Article by Beth Cobb

Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc.  Beth has over twenty-eight years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. 

In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Risk Assessment (CRA) Tool. You may contact Beth at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

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