HFMA’s Regulatory Sound Bites - An Overview of the Final 2013 Inpatient Prospective Payment Rule

Document Sample
HFMA’s Regulatory Sound Bites - An Overview of the Final 2013 Inpatient Prospective Payment Rule  Powered By Docstoc
					    HFMA’s Regulatory Sound Bites

An Overview of the Final 2013 Inpatient Prospective Payment Rule
Dear Member,

This presentation provides a summary of recent regulatory acts and
highlights the features that most affect acute care hospitals. It also offers a
guide to HFMA resources you can use to navigate your organization
through the complicated economic and regulatory environment.

Please feel free to use this presentation to educate your staff and other
hospital stakeholders. If HFMA can be of additional assistance in any way,
please do not hesitate to contact us.

Warmest Regards,
      Presentation Objectives

ØReview the 2013 Final Medicare
 Inpatient Prospective Payment Rule
ØAnalyze Implications for Hospitals
ØIdentify HFMA Resources for
 Addressing These Changes

                Positive Impact
The Final Rule Increases Payments to All Hospitals

                         Reimbursement Impact of the 2013
                                 Final IPPS Rule

                                                                                                  Teaching Status
                          Geographic Area

All Hospitals

                                                 Other Urban Areas


                                                                                                                         <= 100 Residents
                                                                     Rural Areas

                                                                                                       > 100 Residents
                             Large Urban Areas

   Source, pp. pgs 1881-1886

                             Operating Base Rates
    CMS Is Adjusting the Market-Basket Update for Upcoding Related to MS-DRG Implementation

                 IPPS Provisions                                Implications for Hospitals

   • The 2013 final MBU is                                 • The rate increase will increase hospital
    v 2.6% for hospitals submitting quality data             payments by an estimated $2.0 billion in
                                                             FY13, or 2.3 percent.
    v 0.2% for hospitals not submitting quality data
   •The market basket rate-of-increase of                  • Additional reductions are anticipated.
   2.6% will be reduced further by an                        Providers should look for opportunities to
   adjustment of 0.7% for the multifactor                    reduce waste inefficiencies.
   productivity adjustment, less 0.1% (both
   mandated by the ACA), resulting in a net
   payment increase of 1.8 percent.

1. See Appendix 1 for final operating rates

            Capital Base Rates and Payments
                                Capital Payments Are Increased by an Estimated 1.2%
                 IPPS                                                            Implications for
         • CMS establishing an update of 1.2% in                                 Hospitals
           determining the FY13 capital federal rate                       • Additional negative adjustments for
           for all hospitals                                                 documentation and coding should
                                                                             be anticipated
         • CMS not adopting proposal to make an
           additional -0.8% adjustment to the
           national capital rate in FY13 to adjust for
           upcoding as a result of MS-DRG

         • Capital rate established at $425.49 for
           FY13, based on 1.2 % update and other
           budget neutrality factors

1. See Appendix 2 for calculation of FY13 standard federal capital rates

                       Outlier Payments
•   The final outlier fixed-loss cost threshold for FY13 will decrease to $21,821, from
    the current amount of $23,630.

•   CMS using same methodology it proposed to calculate the outlier threshold for
    FY13, using cases from the FY11 MedPAR file (the most recent data available at
    the time of this final rule)

•   Hospital VBP and readmissions payment adjustments excluded from this

•   For FY13, a case would qualify as a cost outlier if the cost for the case plus the
    (operating) IME and DSH payments is greater than the prospective payment rate
    for the MS-DRG, plus the fixed loss amount of $21,821

•   Facilities need to model these changes to understand the full financial impact on

      Quality Data for Payment Update
• For FY14, CMS suspended data collection for four measures beginning with
January 1, 2012, discharges, affecting the FY14 payment determination and
subsequent years

• These measures include:

    vAcute Myocardial Infarction (AMI)
       o AMI-1 Aspirin at arrival
       o AMI-3 ACEI/ARB for left ventricular systolic dysfunction
       o AMI-5 Beta-blocker prescribed at discharge

    v Surgical Care Improvement Project (SCIP)
       o SCIP INF-6 Appropriate Hair Removal

• CMS says the suspension of data collection for these four measures will be
continued unless it has evidence that performance on the measures is in danger of

          Quality Data for Payment Update
                   The rule finalizes a total of 59 measures for FY15 and subsequent years
                IPPS Provisions                                     Implications for Hospitals

• For FY15 CMS adopting all Hospital IQR                        • Providers should make sure they can collect
  Program measures adopted in previous payment                    and submit the additional quality measures
  determinations, with the exception of the 17
  measures                                                      • Processes should be in place to improve
                                                                  performance for each measure
       v Measures that CMS is removing include:
             §1 chart-abstracted measure
             §16 claims-based measures

• For FY15, and subsequent years, the 59
  measures that CMS is finalizing include:

       vNew survey-based measure items for
       inclusion in the HCAHPS survey measure
       v3 claims-based measures
       v1 chart-abstracted measure

• Total of 59 measures for the FY15 payment
  determination and subsequent years

See Appendix 3 for FY15 Hospital IQR quality measures

   Quality Data for Payment Update
Additional IQR Program Measures for FY15                         IQR Program Measures for the FY16

• HCAHPS survey measure: NQF-endorsed 3-Item              • CMS adopted the Safe Surgery Checklist
  Care Transition Measure (CTM-3) (NQF #0228)               Use measure for FY16

• Three claims-based measures:                            •   not NQF-endorsed
        v Hip/Knee Complication: Hospital-level risk-
                                                          • Structural measure assesses whether a
          standardized complication rate (RSCR)
          following elective primary total hip              hospital outpatient department utilizes a
          arthroplasty (THA) and total knee                 Safe Surgery checklist that assesses
          arthroplasty (TKA) (NQF#1550)                     whether effective communication and safe
                                                            practices are performed during three
        v Hip/Knee Readmission: Hospital-Level 30-          distinct perioperative periods:
          Day All-Cause Risk-Standardized
          Readmission Rate (RSRR) Following                         v prior to the administration of
          Elective Total Hip Arthroplasty (THA) and                   anesthesia
          Total Knee Arthroplasty (TKA) (NQF #1551)                 v prior to skin incision
                                                                    v period of closure of incision and
        v Hospital-Wide Readmission (tentative NQF
                                                                      prior to the patient leaving
                                                                      operating room
• New Chart-Abstracted Measure: Elective
  Delivery Prior to 39 Completed Weeks Gestation:         • CMS is finalizing the Safe Surgery Checklist
  Percentage of babies electively delivered prior to 39     use measure for a total of 60 measures for
  completed weeks gestation (NQF #0469)                     the FY 2016 payment determination and
                                                            subsequent years. .

                                       Wage Index
         IPPS Provisions                              Implications for Hospitals
                                                 • Providers should complete the
• For FY13, the wage index will continue to be
                                                 occupational mix index survey
  calculated and assigned to hospitals on the
  basis of the labor market area in which the
  hospital is located                                 v In the FY11 IPPS/LTCH PPS
                                                      proposed rule and final rule,
• CMS defines hospital labor market areas             beginning with the new 2010
  based on the Core-Based Statistical Areas           occupational mix survey, CMS
  (CBSAs)                                             required hospitals that do not submit
                                                      occupational mix data to provide an
       v The FY13 wage index values are
                                                      explanation for not complying.
         based on the data collected from
         the Medicare cost reports
                                                      vCMS instructed FIs/MACs to begin
         submitted by hospitals for cost
                                                      gathering this information as part of
         reporting periods beginning in
                                                      the FY13 wage index desk review
         FY09 (the FY12 wage indices
                                                      process. CMS will review these data
         were based on data from cost
                                                      for future analysis and consideration
         reporting periods beginning
                                                      of potential penalties for
         during FY08)
                                                      noncompliant hospitals.
• The FY13 national average hourly wage
  (unadjusted for occupational mix) is

       Hospital Readmissions Reduction
               IPPS Provisions                                 Implications for Hospitals

• The Hospital Readmissions Reduction Program requires
  a reduction to a hospital’s base operating DRG            • Hospitals should work to
  payment amount to account for excess readmissions of        understand the readmission drivers
  selected applicable conditions:                             within their patient population and
        v acute myocardial infarction
                                                              put programs in place to mitigate
        v heart failure                                       these issues.
        v pneumonia

• Minimum number of discharges for each applicable
  conditions is 25

•   Provision not budget neutral

• For FY13, readmission payment adjustment is the
  higher of ratio of a hospital’s aggregate dollars for
  excess readmissions to their aggregate dollars for all
  discharges, or 0.99 (that is, or a 1-percent reduction)

• Program will result in an estimated 0.3 percent
  decrease, or $280 million, in payments to hospitals

• Secretary can expand the conditions for the program in

• CMS finalized 3 years (7/1/08 to 6/30/11) as the
  applicable period for the FY13 payment adjustment

               Value Based Purchasing
• Under Hospital Value-based Purchasing Program (VBP), value-based incentive payments
  are made in a fiscal year to hospitals that meet performance standards established for a
  performance period for such fiscal year.

• ACA directs the Secretary to begin making value-based incentive payments under the
  Hospital Inpatient VBP Program for discharges occurring on or after October 1, 2012.

• Incentive payments will be funded for FY13 through a reduction to the FY13 base
  operating MS-DRG payment for each applicable hospital’s discharge of 1%.

   vThe applicable percentage for FY14 is 1.25%
   v The applicable percentage for FY15 is 1.5%
   v The applicable percentage for FY16 is 1.75%
   v The applicable percentage for FY17 and subsequent years is 2%

• For the FY13 Hospital VBP Program, CMS previously adopted 13 measures, including 12
  clinical process of care measures and a 13th measure comprising 8 dimensions from the
  Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS).
  The 13 measures were categorized into two domains.

                    Value Based Purchasing
• CMS grouped the 12 clinical process of care measures into a Clinical Process of Care domain, and placed
  the HCAHPS survey measure into a Patient Experience of Care domain.

• CMS adopted a 3-quarter performance period from July 1, 2011, through March 31, 2012, for these
  measures and performance standards on which hospital performance will be evaluated.

• To determine whether a hospital meets or exceeds the performance standards for these measures, CMS
  will assess each hospital’s achievement and improvement during the period as compared with its
  performance during a 3-quarter baseline period from July 1, 2009, through March 31, 2010.

• CMS will then calculate a total performance score (TPS) for each hospital by combining the greater of the
  hospital’s achievement or improvement points for each measure to determine a score for each domain,
  weighting each domain score.

     v For the FY13 Hospital VBP Program, the weights will be clinical process of care = 70 percent,
       patient experience of care = 30 percent. The weighted domain scores will be added together.

• CMS will convert each hospital’s TPS into a value-based incentive payment percentage using a linear
  exchange function and then convert the value-based incentive payment percentage into a per
discharge value-based incentive payment amount.

                     Value Based Purchasing
• For FY14, CMS has adopted 17 measures for the Hospital VBP Program, including:

     v 12 clinical process of care measures from FY13 Hospital VBP Program and the
       HCAHPS measure adopted for the FY13 Hospital VBP Program
     v 1 new clinical process of care measure (SCIP-Inf-9: Postoperative Urinary Catheter
       Removal on Postoperative Day 1 or 2)
     v 3 mortality outcome measures (Acute Myocardial Infarction (AMI) 30-Day Mortality
       Rate, Heart Failure (HF) 30-Day Mortality Rate, Pneumonia (PN) 30-Day Mortality

•Although CMS previously adopted 8 HAC measures, 2 AHRQ composite measures, and a
Medicare Spending Per Beneficiary Measure for the FY14 Hospital VBP Program, it has
suspended the effective date of these measures, with the result that they will not be

See Appendix 4 for FY14 VBP Measures

                        Value Based Purchasing
 • For FY15, CMS will retain 12 of the 13 clinical process of care measures it adopted for the FY14 program

       v CMS finalizing proposal to remove SCIP-Inf-10: Surgery Patients with Perioperative Temperature Management
         from the FY15 Hospital VBP Program because it is “topped-out”

       v SCIP-VTE-1 removed from the Hospital VBP Program measure set beginning with the FY15 Hospital VBP

 • AMI-10 not finalized for FY15 Hospital VBP Program measure because it meets CMS definition of “topped-out”

 •For patient experience of care domain, CMS will retain eight dimensions of the HCAHPS survey adopted for FY13 and
 FY14 Hospital VBP Program

 •For the outcome domain, CMS retains the three 30-day mortality measures finalized for the FY14 Hospital VBP Program

 •Adopts two additional outcome measures for the Outcome domain

       v PSI-90, the AHRQ PSI composite measure
       v CLABSI: Central Line-Associated Blood Stream Infection measure

 • For Efficiency domain, CMS adopts one new measure:

       v Medicare Spending per Beneficiary measure

See Appendix 5 for FY15 VBP measures (please note that although AMI-10 is not finalized for FY15, it
appears in the list of measures published in the final rule, which also appears in the appendix)

                      Value Based Purchasing
 • CMS is not finalizing the proposal to reclassify the Hospital VBP measures into domains
 based on the six priorities of the National Quality Strategy in FY16. It will maintain the
 existing four-domain structure.

 • Will include the 30-day mortality measures, AHRQ PSI composite measure, and other
 measures finalized for the FY15 Hospital VBP measure set (with the exception of the
 CLABSI measure) in the FY16 measure set.

Note: See Appendix 6 for FY15 data collection period and performance standards

                  Disproportionate Share
           IPPS                               Implications for Hospitals
• CMS will adopt a policy that hospitals    • Hospitals submitting claims
  that are required to submit no pay          for services provided to
  bills for services furnished on a           Medicare Advantage enrollees
  prepaid capitation basis by a               for additional IME and direct
  Medicare Advantage organization, or         GME payments, and for
  through cost settlement with an             claims for nursing or allied
  HMO, a competitive medical plan             health education program
  (CMP), a health care prepayment plan        payments, must ensure that
  (HCPP), or a demonstration, for the         they comply with the
  purpose of calculating the DSH              regulations governing time
  patient percentage (DPP), must also         limits for filing claims at §
  do so within the time limits for filing     424.44
  claims specified at § 424.44                  v Under §424.44, time limits for
                                                  filing claims, for services
                                                  furnished on or after January 1,
                                                  2010, the claim must be filed no
                                                  later than the close of the period
                                                  ending 1 calendar year after the
                                                  date of service

                     Disproportionate Share
    Policy Change Relating to Treatment of Labor and Delivery Beds in the Calculation of the Medicare DSH
                           Payment Adjustment and the IME Payment Adjustment

• Under current policy, services furnished to a labor and delivery patient are considered to be
  generally payable under the IPPS, under § 412.105(b)(4), but beds where the services are
  furnished are not available for IPPS-level acute care hospital services

• CMS believes if patient day is counted because the services furnished are generally payable
  under the IPPS, the bed in which the services were furnished should be considered available
  for IPPS-level acute care hospital services

• CMS believes it is appropriate to extend current approach of including labor and delivery
  patient days in the disproportionate patient percentage of the Medicare DSH payment
  adjustment to rules for counting hospital beds for purposes of both the IME payment
  adjustment and the Medicare DSH payment adjustment

          v The rules for counting hospital beds for purposes of the IME payment adjustment are codified in the
            IME regulations at § 412.105(b), which are cross-referenced in § 412.106(a)(1)(i) for purposes of
            determining the DSH payment adjustment

• CMS revises the regulations at § 412.105(b)(4) to remove from the list of currently excluded
  beds those beds associated with ancillary labor/delivery services

•      Will negatively impact IME reimbursement

                                   IME/GME Payments
            IPPS Provisions                                Implications for

• Section 5503 of the ACA added new section           Hospitals that can qualify for additional
1886(h)(8) to the Act providing reductions in FTE
resident caps for direct GME payment purposes
                                                      slots and can fill them should apply
under Medicare hospitals training fewer residents
than their FTE resident caps, and to authorize a
“redistribution” of the estimated number of
excess FTE resident slots to other qualified

• This section amended section 1886(d)(5)(B)(v)
of the Act to require application of the provisions
of section 1886(h)(8) of the Act “in the same
manner” to the IME FTE resident caps

• Cap-building period will increase the from 3
years to 5 years

• CMS is also finalizing the proposed methodology
used to calculate a cap adjustment for an
individual hospital if a new program rotates
residents to more than one hospital (or hospitals)

See Appendix 8 for additional information.

                        IME/GME Payments
•   The methodology is based on the sum of the products of the following three factors:

       • The highest total number of FTE residents trained in any program year, during
         the fifth year of the first new program’s existence at all of the hospitals to which
         the residents in that program rotate

       • The number of years in which residents are expected to complete the program,
         based on the minimum accredited length for each type of program

       • The ratio of the number of FTE residents in the new program that trained at the
         hospital over the entire 5-year period to the total number of FTE residents that
         trained at all hospitals over the entire 5-year period

• CMS finalizing policy under section 5503 and revising the regulations text at
§413.79(n)(2)(ii) to state that if a hospital does not use all of its section 5503 cap award
in its final (12-month or partial) cost report of the 5-year period beginning July 1, 2011,
and ending June 30, 2016, the applicable unused slots will be removed , and the award
will be reduced for portions of cost reporting periods on or after July 1, 2016.

                                      New HACs

v   The hospital-acquired conditions (HACs) payment policy, mandated by the Deficit Reduction
    Act of 2005, prevents hospitals from being paid at higher MS-DRG rate for patients with
    complications or major complications if the sole reason for the higher payment is the occurrence,
    during the beneficiary’s hospital stay, of one of the conditions on the HACs list.

v   CMS adding Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) and
    Iatrogenic Pneumothorax with Venous Catheterization to the HAC payment provision for FY13.

v   CMS finalizing its proposal to add Iatrogenic Pneumothorax with Venous Catheterization with the
    following diagnosis code 512.1 (Iatrogenic pneumothorax) and procedure code 38.93 (Venous
    catheterization NEC).

v    CMS also adding two codes, 999.32 (Bloodstream infection due to central catheter) and 999.33
    (Local infection due to central venous catheter) to the existing Vascular Catheter-Associated
    Infection HAC Category for FY13.

     v CMS is modifying its proposal to add SSI Following CIED Procedures as a HAC condition. CMS’s final policy
       makes SSI following CIED Procedures a sub-HAC condition within the SSI HAC category subject to the HAC
       payment provision for discharges occurring on or after October 1, 2012.

             MDH Program Expiration

vUnder Section 3124 of the ACA, Medicare dependent hospitals (MDHs) currently
 receive the higher of payments made under the federal standardized amount or
 the payments made under the federal standardized amount plus 75 percent of
 the difference between the federal standardized amount and the hospital-specific

vBecause MDH program is not authorized by statute beyond FY12, beginning in
 FY13, all hospitals that previously qualified for MDH status will no longer have
 MDH status and will be paid based on the federal rate

vCMS will allow hospitals currently classified as Medicare dependent hospitals
 (MDHs) to apply for classification as sole community hospitals (SCHs) upon the
 expiration of the MDH program on September 30, 2012

vThe SCH status will be effective the day following the expiration of the MDH

vCMS believes it is difficult to quantify the payment impact of this policy because
 it cannot estimate the number of MDHs that will be applying for SCH status

 Significant Increases/
Decreases in MS-DRGs
MS-DRG                               Description                                       FY      Percent
                                                                         FY 2012
                                                                                      2013      Diff
    682 Renal Failure w MCC                                                  1.641 1.5862       -3.34
    872 Septicemia or severe sepsis w/o MV 96+ hours w/o MCC                1.1339 1.0988       -3.1
    683 Renal Failure w CC                                                  1.0183 0.9958       -2.21
    292 Heart failure & shock w CC                                          1.0214 1.0034       -1.76
    871 Septicemia or severe sepsis w/o MV 96+ hours w MCC                   1.909 1.8803       -1.5
     65 Intracranial hemorrhage or cerebral infarction w CC                 1.1485 1.1345       -1.22
    310 Cardiac arrhythmia & conduction disorders w/o CC/MCC                0.5608 0.5541       -1.19
    191 Chronic obstructive pulmonary disease w CC                          0.9628 0.9521       -1.11
    309 Cardiac arrhythmia & conduction disorders W CC                      0.8155 0.8098       -0.7
    378 G.I. hemorrhage w CC                                                1.0238 1.0168       -0.68
    392 Esophagitis, gastroent & misc digest disorders w/o MCC              0.7421 0.7375       -0.62
    193 Simple pneumonia & pleurisy w MCC                                   1.4948 1.4893       -0.37
    287 Circulatory disorders except AMI, w card cath w/o MCC               1.0743 1.0709       -0.32
    194 Simple pneumonia & pleurisy w CC                                    1.0026 0.9996       -0.3
    192 Chronic obstructive pulmonary disease w/o CC/MCC                    0.7081 0.7072       -0.13
    690 Kidney & urinary tract infections w/o MCC                            0.781    0.781      0
    247 Perc cardiovasc proc w drug-eluting stent w/o MCC                   1.9828 1.9911       0.42
    470 Major joint replacement or reattachment of lower extremity w/o
        MCC                                                                 2.0866 2.0953
    291 Heart failure & shock w MCC                                          1.501 1.5174       1.09
    190 Chronic obstructive pulmonary disease w MCC                         1.1684    1.186     1.51
    312 Syncope & collapse                                                  0.7139 0.7339        2.8
    313 Chest pain                                                          0.5434 0.5617       3.36

                                   HFMA Resources
                          Links to HFMA Resources Addressing IPPS-Related Challenges
HFMA provides additional information on the following:

IIPS Final Rule:
HFMA’s Medicare’s Final Inpatient Payment Rule for FY13 Webinar
Larry Goldberg provides commentary on the 2013 final Medicare rule.

Value-Based Purchasing:
Hospital Inpatient Value-Based Purchasing Program Fact Sheet
Discusses the value-based purchasing program, including scoring methodologies, thresholds, benchmark targets, and

Hospital Readmissions:
Hospital Readmissions Reduction Program Overview
Provides a summary of the various aspects of the Hospital Readmissions Reduction Program.

For questions regarding this presentation or the final IPPS
                  Rule, please contact:

                    Chad Mulvany
                  Technical Director

                 1825 K Street, NW
                     Suite 900
               Washington, D.C. 20006

                Office: 202.238-3453

Ø Appendix I: Final IPPS Base Rates/Standard
  Operating Amounts
Ø Appendix II: Standard Federal Capital Rates
Ø Appendix III: FY15 Hospital IQR Quality
Ø Appendix IV: FY14 VBP Measures
Ø Appendix V: FY15 VBP Measures
Ø Appendix VI: FY15 Data Collection Period
Ø Appendix VII: FY15 Performance Standards
Ø Appendix VIII: Resident Cap Ranking Criteria

Appendix I: Final IPPS Base Rates/Standard
            Operating Amounts
                  National Adjusted Operating Standardized Amounts
   (68.8 Percent Labor Share/31.2 Percent Nonlabor if Wage Index Is Greater Than 1)

               National Adjusted Operating Standardized Amounts
               (62 Percent Labor Share/38 Percent Nonlabor Share
                    if Wage Index Is Less Than or Equal To 1)

       Adjusted Operating Standardized Amounts for Puerto Rico,

Appendix 2: Final IPPS Base Rate
 Standard Federal Capital Rate

Appendix 3: FY15 Hospital IQR Quality
        Topic                      Hospital IQR Program Measures for FY15 Payment
                                   Determination and Subsequent Years
        Acute Myocardial Infarction (AMI) Measures
                                         AMI-2 Aspirin prescribed at discharge

                                         AMI-7a Fibrinolytic (thrombolytic) agent received
                                          within 30 minutes of hospital arrival
                                         AMI-8a Timing of Receipt of Primary Percutaneous
                                          Coronary Intervention (PCI)
                                         AMI-10 Statin Prescribed at Discharge

        Heart Failure (HF) Measures
                                         HF-1 Discharge instructions

                                         HF-2 Evaluation of left ventricular systolic function

                                         HF-3 Angiotensin Converting Enzyme Inhibitor
                                          (ACE-I) or Angiotensin II Receptor Blocker (ARB)
                                          for left ventricular systolic dysfunction

        Stroke (STK) Measure Set
                                         STK-1VTE prophylaxis

                                         STK-2 Antithrombotic therapy for ischemic stroke
                                         STK-3 Anticoagulation therapy for Afib/flutter

                                         STK-4 Thrombolytic therapy for acute ischemic
                                         STK-5 Antithrombotic therapy by the end of hospital
                                          day 2
                                         STK-6 Discharged on Statin

                                         STK-8 Stroke education

                                         STK-10 Assessed for rehab

Appendix 3 (continued): FY15 Hospital
       IQR Quality Measures
      Topic                                               Hospital IQR Program Measures for FY15 Payment
                                                          Determination and Subsequent Years
      VTE Measure Set
                                                               VTE-1 VTE prophylaxis
                                                               VTE-2 ICU VTE prophylaxis
                                                               VTE-3 VTE patients with anticoagulation overlap
                                                               VTE-4 Patients receiving un-fractionated Heparin
                                                                with doses/labs monitored by protocol
                                                               VTE-5 VTE discharge instructions
                                                               VTE-6 Incidence of potentially preventable VTE
      Pneumonia (PN) Measures
                                                               PN-3b Blood culture performed in the emergency
                                                                department prior to first antibiotic received in hospital
                                                               PN-6 Appropriate initial antibiotic selection
      Surgical Care Improvement Project (SCIP) Measures
                                                               SCIP INF-1 Prophylactic antibiotic received within 1
                                                                hour prior to surgical incision
                                                               SCIP INF-2: Prophylactic antibiotic selection for
                                                                surgical patients
                                                               SCIP INF-3 Prophylactic antibiotics discontinued
                                                                within 24 hours after surgery end time (48 hours for
                                                                cardiac surgery)
                                                               SCIP INF-4: Cardiac surgery patients with controlled
                                                                6AM postoperative serum glucose
                                                               SCIP INF-9: Postoperative urinary catheter removal
                                                                on post operative day 1 or 2 with day of surgery
                                                                being day zero
                                                               SCIP INF-10: Surgery patients with perioperative
                                                                temperature management

Appendix 3 (continued): FY15 Hospital
       IQR Quality Measures
      Topic                             Hospital IQR Program Measures for FY15 Payment Determination
                                        and Subsequent Years
                                               SCIP Cardiovascular-2: Surgery Patients on a Beta Blocker
                                                prior to arrival who received a Beta Blocker during the
                                                perioperative period
                                               SCIP-VTE-2: Surgery patients who received appropriate VTE
                                                prophylaxis within 24 hours pre/post surgery
      Mortality Measures (Medicare Patients)
                                               Acute Myocardial Infarction (AMI) 30-day mortality rate
                                               Heart Failure (HF) 30-day mortality rate
                                               Pneumonia (PN) 30-day mortality rate
      Patients' Experience of Care Measures
                                               HCAHPS survey (expanded to include one 3-item care
                                                transition set* and two new “About You” items)
      Readmission Measures (Medicare Patients)
                                               Acute Myocardial Infarction 30-day Risk Standardized
                                                Readmission Measure
                                               Heart Failure 30-day Risk Standardized Readmission Measure
                                               Pneumonia 30-day Risk Standardized Readmission Measure
                                               30-day Risk Standardized Readmission following Total Hip/Total
                                                Knee Arthroplasty*
                                               Hospital-Wide All-Cause Unplanned Readmission (HWR)*
      AHRQ Patient Safety Indicators (PSIs) Composite Measures
                                               Complication/patient safety for selected indicators (composite)
      AHRQ PSI and Nursing Sensitive Care
             PSI-4 Death among surgical inpatients with serious treatable complications
      Structural Measures
                                               Participation in a Systematic Database for Cardiac Surgery
                                               Participation in a Systematic Clinical Database Registry for
                                                Stroke Care
                                               Participation in a Systematic Clinical Database Registry for
                                                Nursing Sensitive Care
                                               Participation in a Systematic Clinical Database Registry for
                                                General Surgery

Appendix 3 (continued): FY15 Hospital
       IQR Quality Measures
      Topic                               Hospital IQR Program Measures for FY15 Payment Determination and
                                          Subsequent Years
      Healthcare-Associated Infections Measures
                                               Central Line Associated Bloodstream Infection
                                                Surgical Site Infection
                                                Catheter-Associated Urinary Tract Infection
                                                MRSA Bacteremia
                                                Clostridium Difficile (C.Diff)
                                                Healthcare Personnel Influenza Vaccination
      Surgical Complications
                                                Hip/Knee Complication: Hospital-level Risk-Standardized
                                          Complication Rate (RSCR) following Elective Primary Total Hip
      Emergency Department (ED)Throughput Measures
                                                ED-1 Median time from emergency department arrival to time of
                                                 departure from the emergency room for patients admitted to the
                                                ED-2 Median time from admit decision to time of departure from the
                                                 emergency department for emergency department patients
                                                 admitted to the inpatient status
      Prevention: Global Immunization (IMM) Measures
                                                Immunization for Influenza
                                                Immunization for Pneumonia
      Cost Efficiency
                                                Medicare Spending per Beneficiary
      Perinatal Care
                                          Elective delivery prior to 39 completed weeks of gestation

Appendix 4: FY14 VBP Measures

Appendix 5: FY15 VBP Measures

Appendix 6: FY15 Data Collection

Appendix 7: FY15 Performance Standards

Appendix 8: Resident Cap Ranking

Appendix 8 (continued): Resident Cap
          Ranking Criteria


Shared By: