Qual­ity re­port­ing ex­pands

In­pa­tient re­hab, hospice are added to pro­gram

Modern Healthcare - - The Week In Healthcare - Paul Barr

In­pa­tient re­ha­bil­i­ta­tion and hospice providers are get­ting ready to en­ter the world of Medi­care qual­ity re­port­ing with vary­ing de­grees of en­thu­si­asm. The CMS on April 22 re­leased its plan for the in­pa­tient re­ha­bil­i­ta­tion fa­cil­ity qual­ity re­port­ing pro­gram, which in­cludes two pro­posed mea­sures and a prob­a­ble third mea­sure un­der de­vel­op­ment, and if im­ple­mented would even­tu­ally af­fect in­pa­tient re­hab re­im­burse­ment.

In­pa­tient re­hab fa­cil­i­ties not re­port­ing on the mea­sures in the pro­gram as pro­posed would have their re­im­burse­ment change from Medi­care re­duced by 2 per­cent­age points in fis­cal 2014, which be­gins Oct. 1, 2013.

The pro­gram over­all would af­fect about 1,000 in­pa­tient re­hab units in acute-care and crit­i­cal ac­cess hos­pi­tals and 200 free-stand­ing fa­cil­i­ties, ac­cord­ing to the CMS.

The CMS plans to add mea­sures af­fect­ing Medi­care pay­ment for fis­cal 2015, draw­ing from 26 mea­sures listed in the pro­posed rules that in­clude top­ics re­ported on for short-stay nurs­ing home pa­tients. (See p. 17 for more on new Na­tional Qual­ity Fo­rum nurs­ing home mea­sures.)

Ex­ec­u­tives from the re­hab in­dus­try say they are be­hind the ef­fort to im­prove qual­ity and are go­ing to par­tic­i­pate in the qual­ity re­port­ing, though ques­tions were raised about whether the mea­sures to be used are the best gauges of in­pa­tient re­hab qual­ity.

“It’s good for folks to be think­ing about qual­ity, (they) just need to do it ra­tio­nally and sen­si­bly,” said Dr. Bruce Pomer­anz, med­i­cal di­rec­tor for Kessler In­sti­tute for Re­ha­bil­i­ta­tion, West Orange, N.J., and chief qual­ity of­fi­cer for the re­hab divi­sion of Se­lect Med­i­cal Corp., Me­chan­ics­burg, Pa. Pomer­anz said that no mat­ter which mea­sures were picked to start the pro­gram, they are likely to not nec­es­sar­ily be the best rep­re­sen­ta­tion of re­hab care qual­ity.

He said Kessler and its par­ent Se­lect Med­i­cal give a lot of at­ten­tion to in­pa­tient re­hab care qual­ity, and are more fo­cused on broader med­i­cal and func­tional out­comes. Pomer­anz said he is not sure the CMS mea­sures will ac­cu­rately cap­ture qual­ity at the broader lev­els. “At some lev­els, these mea­sures are a very small piece of what for us is the whole mis­sion of pro­vid­ing” high qual­ity care, he said.

Mark Tarr, chief op­er­at­ing of­fi­cer of HealthSouth Corp., Birm­ing­ham, Ala., said the qual­ity pro­gram and its el­e­ments were not a sur­prise. “We ap­plaud the push,” he said. The ar­eas of ini­tial fo­cus by the qual­ity pro­gram are also pri­or­i­ties for HealthSouth, and com­pany of­fi­cials are OK with the mea­sures se­lected, Tarr said.

Of the two mea­sures al­ready pro­posed by the CMS, one tar­gets catheter-associated uri­nary-tract in­fec­tions, a mea­sure en­dorsed by the NQF for hos­pi­tals, but one that the CMS be­lieves ap­plies to the in­pa­tient re­hab set­ting, ac­cord­ing to the pro­posed rule. The CMS pro­poses that re­port­ing on this mea­sure be done

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