CMS Announces Results of Hospital Quality Reporting

The Centers for Medicare and Medicaid Services (CMS) has notified more than 3,000 of the nation’s hospitals that they will receive the full payment update for calendar year (CY) 2009 as part of the new Hospital Outpatient Quality Data Reporting Program.

The successful hospitals represent 99.3% of all hospitals that participated in the program that began in 2008 as an effort to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments and the payments hospitals receive for those services.

“We are extremely pleased to find that hospitals have responded so successfully to the new outpatient quality measure reporting program,” Kerry Weems, CMS acting administrator, said in a news release. “The reporting program represents another major step toward value-based purchasing of health care services to ensure that patients with Medicare and the American taxpayers get the best outcomes for their health care dollars.”

The new reporting program was mandated by the Tax Relief and Health Care Act (TRHCA) of 2006, and applies to all hospitals paid under the hospital outpatient prospective payment system (OPPS). The program does not apply to:

  • Hospitals excluded from the OPPS
  • Maryland hospitals subject to special payment rules reflecting state hospital payment laws
  • Hospitals situated outside of the 50 states, the District of Columbia and Puerto Rico
  • Indian Health Service Hospitals
  • Certain other OPPS-exempt hospitals.

Under TRHCA, eligible hospitals that successfully report outpatient quality data receive the full market basket update. For those that do not receive an update, that is reduced by 2%. Data culled from the hospital reporting program will help Medicare and the broader health care community learn more about the quality of services available to beneficiaries in outpatient care settings and how to improve that care. Quality data will also give CMS a baseline of data from which an eventual pay-for-performance outpatient system could be created.

In all, of 3,339 hospitals that participated in the program, 3,313 will receive the full CY 2009 update under the quality data reporting program. Of the remaining 26, that will receive the reduced update, 18 did not report the quality data successfully, while eight did not have a QualityNet Administrator.

In 2008, hospitals participating in the program were required to report data on the seven quality measures that measure important elements of high-quality heart attack and surgical care, which is of particular importance to Medicare beneficiaries. These measures were:

  • The percentage of heart attack patients given aspirin when they arrive at the emergency room
  • The amount of time it takes for a heart attack patient to receive clot-busting drugs
  • The percentage of heart attack patients who received clot-busting drugs within 30 minutes of arriving in the emergency room
  • The average time it takes a heart attack patient to receive an electrocardiogram test to assess heart damage once they arrive in the emergency room
  • The average time it takes for a heart attack patient to transfer to another hospital to receive a coronary angioplasty as acute treatment for a heart attack
  • The percentage of surgery patients who receive an antibiotic within one hour before surgery to help prevent infection
  • The percentage of surgery patients who receive the right kind of antibiotic to help prevent infection.

The OPPS CY 2009 final rule added four imaging efficiency measures to the seven original measures for reporting to receive the full update in CY 2010.

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