Against the rule

CMS’ ef­fi­ciency, cost link raises ob­jec­tions

Modern Healthcare - - The Week In Healthcare - Jes­sica Zig­mond

Hos­pi­tals and health­care con­sul­tants have se­ri­ous con­cerns about changes to the hos­pi­tal value-based pur­chas­ing pro­gram the CMS tucked into its pro­posed rule for out­pa­tient care.

The com­ment pe­riod closed last week on pro­posed reg­u­la­tions is­sued July 1 that in­cluded rec­om­men­da­tions to bol­ster the value-based pur­chas­ing pro­gram re­quired by last year’s Pa­tient Pro­tec­tion and Af­ford­able Care Act. The pro­gram will tie a por­tion of a hos­pi­tal’s pay­ment for in­pa­tient stays un­der the in­pa­tient prospec­tive pay­ment sys­tem to its per­for­mance score on a set of qual­ity mea­sures start­ing in 2013.

In April, the CMS is­sued a fi­nal rule on the pro­gram that estab­lished 12 clin­i­cal process-of­care mea­sures that would be used in de­ter­min­ing a hos­pi­tal’s per­for­mance. The reg­u­la­tions pro­posed in July added one clin­i­cal process-of­care mea­sure to pre­vent uri­nary catheter in­fec­tions, and also ad­dressed per­for­mance pe­ri­ods, stan­dards and a weight­ing scheme.

The first year of the pro­gram will in­clude a process-of-care do­main and pa­tient-sat­is­fac­tion do­main and then in 2014 will in­cor­po­rate ef­fi­ciency-of-care and out­comes do­mains, said Jes­sica Roth, di­rec­tor of leg­is­la­tion and health pol­icy at the Wash­ing­ton-based law firm of McDer­mott, Will & Emery. Roth said her clients are most con­cerned about the ap­proach to ef­fi­ciency, which hos­pi­tals have his­tor­i­cally viewed in terms of lengths of stay.

“CMS de­cided to take a dif­fer­ent ap­proach and mea­sure ef­fi­ciency through cost,” she said. The CMS will mea­sure to­tal Medi­care spend­ing per ben­e­fi­ciary and then at­tribute that spend­ing to the hos­pi­tal. As she ex­plained, after a pa­tient en­ters a hos­pi­tal, the CMS will take into ac­count all of the care for a 30-day pe­riod to de­ter­mine spend­ing on that ben­e­fi­ciary.

The Amer­i­can Hos­pi­tal As­so­ci­a­tion and the Fed­er­a­tion of Amer­i­can Hos­pi­tals wrote in com­ment let­ters that they are con­cerned with the new mea­sure be­cause it has not been en­dorsed by the Na­tional Qual­ity Fo­rum or any other qual­ity or­ga­ni­za­tion.

The new pro­vi­sions also have drawn crit­i­cism for ex­tend­ing the 2013 pro­gram’s re­liance on the Hos­pi­tal Con­sumer Assess­ment of Health­care Providers and Sys­tems sur­vey. Hos­pi­tals fear they’ll be un­fairly pe­nal­ized for treat­ing sicker pa­tients, who tend to give lower sat­is­fac­tion scores (July 11, p. 10).

In its com­ment let­ter last week, the AHA ex­pressed con­cern about the way the CMS has han­dled the no­tice and com­ment pe­riod for the value-based pur­chas­ing pro­gram. “CMS made sig­nif­i­cant changes to this pro­gram in three sep­a­rate reg­u­la­tions,” the let­ter said. “It has been very dif­fi­cult to track all of the mov­ing pieces as­so­ci­ated with these reg­u­la­tions.”

The CMS is sched­uled to is­sue the fi­nal rule on the out­pa­tient prospec­tive pay­ment rule by Nov. 1.

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