Re­port­ing post-acute qual­ity

With new pay rules, providers re­cep­tive to changes

Modern Healthcare - - Front Page - Mau­reen McKin­ney

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.”

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