Quality reporting expands
Inpatient rehab, hospice are added to program
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