I’ve been reading a recent edition of Modern Healthcare, and my blood started simmering again.
Reporter Maureen McKinney’s excellent overview of what’s coming down the road with more CMS reporting requirements for hospitals to qualify for their annual full marketbasket adjustments gives us a sense of where the government is going to accomplish two overarching goals (“Can’t drive 55,” April 26, p. 6): 1. Improving quality of care across the country. 2. Generating significant cost savings by withholding Medicare payments for offquality events. It’s a continuation of a philosophy that started with DRG fixed reimbursement in the mid-1980s: If hospitals won’t reduce length of stay and resource utilization voluntarily, the CMS will force them to contain costs and let market forces allow the strongest to thrive. The rollout calendar looks a bit like this: Jan. 1, 2011: Ten new measures to be reported (eight hospital-acquired conditions, including: blood incompatibility, urinary tract infections and other catheter infections, and effects of poor glycemic control, plus two Agency for Healthcare Research and Quality patient-safety indicators, including postoperative pulmonary embolism/deep vein thrombosis and postoperative respiratory failure) with final approval pending.
2011: Thirty-five additional measures reported, but these would not be used to determine annual payment updates until 2013.
2012: Four more measures reported (two for emergency room throughput and two for immunizations) for annual payment updates in 2014.
Future: Twenty-eight more measures not required for reporting, but used for future rulemaking.
So naturally the bickering has started around how expensive it will be to collect the data, how accurate the data will be, how the measures aren’t rooted in science, how the reporting parameters aren’t clear, how rural hospitals will carry an undue burden, etc. Blah, blah, blah.
I revert back to my earlier observation of what the federal government’s long-term strategy is: If you won’t do it yourself, we’ll force the waste out of the system and let Darwinian theory play out. Do you think the CMS really cares about how you get there? You’re all smart people making nice salaries. You figure it out.
We’ve seen many Healthcare Management Council clients demonstrate major improvements between 2008 and 2009 in several AHRQ off-quality indicators, such as decubitis ulcers, postoperative pulmonary embolism/deep vein thrombosis, and postoperative respiratory failure.
Yes, some may be from better documentation of present on-admission status, but most of the improvement stems from actually doing something about reducing the incident rates for these indicators. This translates into huge cost savings and better patient care. And it’s happened only because now they are at risk for losing reimbursement. It’s amazing what can happen when your survival depends on it.
The truth is that most facilities are already capturing the data for most of these indicators, and they have structures, databases and resources in place to handle these and the additional measures. The fact that reimbursement will continue to be withheld for underperformers is no longer negotiable. These are events that for the most part shouldn’t be happening in hospitals anyway, so stop your whining and start figuring out how you’re going to improve care. John Whittlesey
Principal Healthcare Management Council