Reporting post-acute quality
With new pay rules, providers receptive to changes
The rush to improve quality through the use of performance measures is extending far beyond acute-care hospitals, as evidenced by recent moves by the CMS and Joint Commission. But despite the potential for additional reporting burdens, providers seem to have embraced the latest changes as appropriate and necessary.
On July 21, after years of collaboration with behavioral health associations and other stakeholders, the Joint Commission revealed a set of seven core performance measures for hospital-based inpatient psychiatric services. And just days later, the CMS issued a proposed rule that would create a quality improvement program, or QIP, for facilities that provide end-stage renal disease services to Medicare beneficiaries.
“We have definitely seen an increase in the use of quality measures across a wide variety of settings including home health and ambulatory care,” said Helen Burstin, senior vice president for performance measures at the National Quality Forum. “I think you are starting to see people really accept that there are going to be new models of payment and they want the measures to be the right ones. There is the sense that change is coming.”
Reporting on six of the seven new behavioral health measures, which include hours of seclusion, hours of restraint use and number of patients discharged on multiple anti-psychotic medications, will be required for receiving accreditation from the Oakbrook Terrace, Ill.-based Joint Commission, starting Jan. 1, 2011.
One of the measures—admission screening for violence risk, substance abuse, history of psychological trauma and patient strength—has yet to be approved by the NQF so although providers will be asked to report on it, it won’t be considered mandatory, said Jerod Loeb, executive vice president for quality measurement and research at the Joint Commission.
The measures are expected to bring some order to psychiatric quality reporting. “We realized that there were so many reporting initiatives in place, but there was no coordination and every hospital was reporting differently,” said Kathleen McCann, director of quality and regulatory affairs at the National Association of Psychiatric Health Systems. “We knew we needed to find standardized definitions and standardized reporting mechanisms so we could look across the industry at things we thought were critically important.”
The Joint Commission worked with the NAPHS, National Association of State Mental Health Program Directors and its research institute, American Psychiatric Association and clinicians at more than 300 inpatient psychiatric hospitals who pilot-tested the measures. The result, McCann said, is a shortlist of actionable measures that are owned by the field.
“I think they did a great job in terms of outreach to stakeholders,” said Jeffrey Borenstein, CEO and medical director of 125-bed Holliswood Hospital, New York, an inpatient psychiatric hospital. “The measures were developed carefully and they’re things hospitals should be looking at anyway. The only difference is now we’ll have national benchmarks and we’ll be able to see where we are performing relative to everyone else.”
The core measures could also be used in future value-based purchasing programs, Loeb said, but even more rigorous analysis would be required first.
Regarding the renal-care measures, the CMS included three initial performance measures to be used in evaluating end-stage renal disease providers: one related to hemodialysis adequacy and two related to anemia management. If facilities’ performance scores on those measures fall below set standards, they could see their dialysis services payments cut by up to 2% starting Jan. 1, 2012, the CMS said.
In addition, the CMS issued a final rule establishing an end-stage renal disease prospective payment system, set to begin on Jan. 1, 2011, which finalized the measures. In other words, the final rule established the three measures that will be used in the QIP while the proposed rule describes how the
McCann: Had to find standard definitions, reporting mechanisms.
Jackson: “We agree with CMS that this is a good place to start.”