It’s been almost five months after CMS publicly released its hospital star ratings system amidst widespread controversy and opposition. Now, a new study by WalletHub has provided evidence that hospitals’ ratings are highly linked to their location and socioeconomic factors.
Ever since CMS announced the star system, many had argued that it was biased against facilities that treat impoverished, sicker patients. To study this, WalletHub looks at the ratings of 657 hospitals in 150 cities across the U.S. comparing ratings to each city’s “stress level,” a composite of stressor caused by work, money, family, and health and safety.
Hospitals in Detroit and Newark, N.J. (the first and ninth most stressed cities) earned an average of 1.5 and one stars respectively. However, hospitals in the California cities of Fremont and Irvine (the least and second-least stressed cities) earned an average of three and five stars, respectively. Meanwhile, CMS reports that safety net hospitals earn slightly lower ratings on average compared to non-safety net hospitals (2.88 to 3.09 stars).
“When we look at hospital quality ratings and rankings, what we are seeing has less to do with what the hospitals themselves are doing and more to do with the communities they are located in and the patients they serve,” said David Nerenz, co-author of the study and the director of the Center for Health Policy and Health Services Research at the Henry Ford Health System in Detroit, to Modern Healthcare. [more]
CMS last week released a list of 97 reporting measures for hospitals, clinician practices, nursing homes, dialysis facilities, and other settings. The measures are being considered for use in Medicare’s quality and value-based purchasing programs.
This year, 39% of the measures focus on patient outcomes, while the remainder focus on patient safety, cost, and appropriate use of diagnostics and services. There was also an increase in measures submitted by specialty societies. CMS annually publishes a list of potential Medicare quality measures to hear back from patients, clinicians, payers, and purchasers on the which measures they think are the best. CMS is teaming up with the National Quality Forum (NQF) for the sixth year in a row on this effort. The feedback the NQF collects will be sent to the multi-stakeholder Measure Applications Partnership (MAP) for consideration.
“We invite you to review the Measures under Consideration List in detail and to participate in the public process during the MAP review,” wrote Kate Goodrich, MD, MHS, CMS director of the Center for Clinical Standards & Quality, in a blog post. “We believe it is critically important to hear all voices in the selection of quality and efficiency measures that are used for accountability and transparency purposes and look forward to another successful pre-rulemaking season. We are committed to working with patients, clinicians, and others on how to best measure the quality and value of care while reducing burden on providers and driving improved outcomes for patients at lower costs.”
The proposed measures are available on CMS and NQF websites, and comments on can be made until 6 p.m. on December 2 at the NQF website.
As of today, CMS, The Joint Commission, and HFAP will be surveying hospitals to the 2012 Life Safety Code® (LSC). The LSC was adopted by CMS in June, with some of the big changes required under the final rule including:
- Facilities located in buildings taller than 75 feet are required to install automatic sprinkler systems within 12 years after the rule’s effective date.
- Facilities are required to have a fire watch or building evacuation if their sprinkler systems is out of service for more than 10 hours.
- Greater flexibility for long-term care (LTC) facilities in what they can place in corridors. LTC facilities will be able to include more home-like items such as fixed seating in the corridor for resting and certain decorations in patient rooms.
- Fireplaces will be permitted in smoke compartments without a one-hour fire wall rating, which makes a facility more home-like for residents.
- For ambulatory surgical centers, alcohol-based hand rub dispensers now may be placed in corridors to allow for easier access.
- Fire watches must be continuous, “constantly circulating” through impaired
- All side-hinged swinging fire doors must be tested annually.
- Once every five years, an internal inspection of sprinkler pipe is required.
- Fire hose valves must be inspected quarterly and tested annually/every three years, depending on size.
- 1-hour fire-rated barriers are required between non-sprinklered construction areas and occupied egress areas.
Visit the Federal Register to see the full list of changes
On October 13, CMS announced a push to improve physician engagement and their experience within the Medicare system. To achieve this goal, the agency is trying to reduce the reduce administrative burdens that physicians have to handle with the new Medicare Access and CHIP Reauthorization Act (MACRA).
“Physicians and their care teams are the most vital resource a patient has. As we implement the Quality Payment Program under MACRA, we cannot do it without making a sustained, long-term commitment to take a holistic view on the demands on the physician and clinician workforce,” said Andy Slavitt, CMS Acting Administrator, in a press release. “The new initiative will launch a nationwide effort to work with the clinician community to improve Medicare regulations, policies, and interaction points to address issues and to help get physicians back to the most important thing they do—taking care of patients.”
CMS has begun an 18-month pilot program to reduce medical reviews for certain physicians. The pilot will relieve some of the scrutiny that certain types of advanced Alternative Payment Models (APM) providers receive for medical review programs. Advanced APMs were considered for this pilot they share financial risk with the Medicare program, giving them a powerful motivation to deliver the most efficient care possible. Once the pilot is over, CMS will analyze the results to see if they can be replicated in additional advanced APMs, specialties, and provider types.
“Like all successful changes, we will begin with the basic steps and build over time,” said Ashby Wolfe, MD, MPP, MPH, Region IX chief medical officer. “Most importantly, we are excited to build on the listening and engagement process we began this year by creating more opportunities for physicians to interact with CMS, especially through our regional offices.”
The Government Accountability Office (GAO) sent a report on October 13 to the Department of Health and Human Services (HHS) urging for better alignment of healthcare quality measures. The conclusion of the 42-page document is that payers haven’t agreed on what quality measures to track, which puts a burden on healthcare organizations.
“For example, a physician may participate in Medicare and a private health plan that each use different measures for assessing the care of diabetic patients,” the GAO wrote. “In another example, a physician may report similar measures to multiple payers that assess blood sugar levels among diabetic patients, but each measure may use a different threshold to determine which patients have their blood sugar levels under control.”
The GAO says there are three main drivers of these misalignments:
- Dispersed decision-making:Each public and private payer decides which quality measures they want to use and which specifications apply. This is done without regard to the measures that other payers are using.
- Variation in data collection and reporting systems:The electronic health record (EHR) systems, paper records, or clinical data registries that physicians use all differ in how they collect and report quality data. Without standard measures, there’s little incentive for EHR vendors to create systems to facilitate data collection and reporting.
- Few meaningful measures:Of the hundreds of quality measures currently used, only a few are seen as leading to meaningful quality improvements.
“What we have right now is a labyrinth of confusing metrics, specifications and reporting rules that serve no one,” said Kathleen Ciccone, RN, introducing a Healthcare Association of New York State report calling for streamlined measures.
The GAO report recommends that HHS, CMS, and the Office of the National Coordinator for Health Information Technology develop a comprehensive plan, including timelines, for more meaningful quality measures and electronic quality measures. The GAO particularly wants to see the creation of standardized data elements to report on core electronic quality measures.
Hospitals will face new requirements for getting Health Insurance Marketplace (HIM) plans starting on January 1, 2017. The final rule, which was issued by CMS this year, says that hospitals with 50 beds or more can only receive HIM insurance if they:
- Work with a Patient Safety Organization (PSO).
- Are a member of a Quality Improvement Organization.
- Are a member of a Hospital Engagement Network.
- Are accredited by The Joint Commission.
- Implement an evidence-based initiative to improve healthcare quality through the collection, management, and analysis of patient safety events. The initiatives must meet reasonable exception criteria.
The Agency for Healthcare Research and Quality has a list of all the PSOs that apply for the rule. For more information on the new rule and it’s reasonable exception criteria, you can view CMS’ presentation and accompanying Q&A.
Six Pediatric Quality Measures Program (PQMP) grantees have been given $13.4 million to test new pediatric quality measures over the next four years. The money is being provided by CMS and The Agency for Healthcare Research and Quality (AHRQ) with funds from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“Medicaid and Children’s Health Insurance Programs (CHIP) give millions of children in the United States a healthy start,” said Vikki Wachino, director at the Center for Medicaid and CHIP Services, in a press release. “Through efforts such as this PQMP funding, we are able to advance states’ efforts to measure and report meaningful improvements in the quality of care for children.”
The pediatric measures were created by the PQMP Centers for Excellence with the goal of creating a portfolio of evidence-based, consensus pediatric quality measures available to public and private purchasers of children’s health care services. Grantees will be expected to test the feasibility and usability of the measures in in real-world settings at the state, health plan, and provider levels.
“The PQMP Centers of Excellence provided us with valid measures of children’s health care quality. This next step of research will help us test these measures in real-world settings,” said AHRQ director Andy Bindman, MD. “The ultimate goal is to improve children’s health through better health care, at lower costs, at both the federal and state level.”
Between 2010 and 2015, hospital readmission rates have dropped an average of 8% nationally, with 100,000 unnecessary patient readmissions avoided in 2015 alone. CMS reported the news on its blog, stating that 49 states and the District of Columbia have seen reductions in avoidable 30-day readmissions of Medicare patients over the past five years.
Readmissions reduction has been a major goal for CMS, with an estimated $17 billion in Medicare spending spent annually on avoidable hospital readmissions. The agency also announced that it would be increasing its fines for high readmission rates in fiscal 2017. While hospitals may look to this new data as a sign of hope, a study in The New England Journal of Medicine cautions that the continuing the drop may not be possible.
“Presumably, hospitals made substantial changes during the study period but could not sustain such a high rate of reductions in the long term,” the authors wrote. [more]
A proposed CMS change to the 2017 Medicare Physician Fee Schedule will require surgeons document and report data every 10 minutes for new billing codes (G-codes). The penalty for not submitting this data is 5% of a facility’s Medicare reimbursement.
CMS’ plans to phase out 10-day and 90-day global surgery packages over the next two years. Instead, the fee schedule would have a zero-day package, with all preoperative and postoperative care bundled together on the day of the surgery. Surgeons would receive a lump sum for their work and bill CMS on a piecemeal basis for care provided before and after the day of surgery.
Surgeons and medical groups have loudly decried the move, calling it impractical, untested, and a huge waste of time and money. In one survey of 7,000 surgeons, 37% said the new codes will cost them between $25,000 and $100,000 per surgeon. Fifteen percent said it would cost them over $100,000 in hiring scribes to keep up with documentation, updating electronic health records, and having less time for patients.
Respondents also claimed that if the standards go into effect:
• 85.9% will have to modify EHR and billing systems
• 88.8% of physicians and 75.7% of staff will lose time tracking and processing global surgery information into EHR and billing systems
• 82.8% will have to develop new tracking and collecting methods for global surgery data
• 46.4% will need to buy more technology (such as handheld devices or stopwatches) to document time spent providing global surgery services
So far, the American College of Surgeons (ACS), the American Association of Orthopaedic Surgeons, the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), the American Medical Association, and several others have filed protests with CMS.
“The claims-based data collection mandate is so burdensome that most physicians will not be able to comply by January 1, 2017, which will result in CMS being unable to collect accurate and usable data, particularly in light of the unfinished final rule at the time of this writing,” the AANS and CNS wrote in a letter to CMS.
For more, read the full article at HealthLeaders Media.
CMS announced yesterday that it had finalized new emergency response requirements for healthcare providers participating in the Medicare or Medicaid system. The new rule comes as a response to a string of disasters, natural and mad-made, including the recent flooding in Louisiana. The rule requires that healthcare providers meet the following four standards:
- Emergency plan: Based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of a provider or supplier.
- Policies and procedures: Develop and implement policies and procedures based on the plan and risk assessment.
- Communication plan: Develop and maintain a communication plan that complies with both Federal and State law. Patient care must be well-coordinated within the facility, across health care providers, and with State and local public health departments and emergency systems.
- Training and testing program: Develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan.
“As people with medical needs are cared for in increasingly diverse settings, disaster preparedness is not only a responsibility of hospitals, but of many other providers and suppliers of healthcare services. Whether it’s trauma care or long-term nursing care or a home health service, patients’ needs for health care don’t stop when disasters strike; in fact, their needs often increase in the immediate aftermath of a disaster,” said Dr. Nicole Lurie, Health and Human Services assistant secretary for preparedness and response, in a press release. “All parts of the healthcare system must be able to keep providing care through a disaster, both to save lives and to ensure that people can continue to function in their usual setting. Disasters tend to stress the entire health care system, and that’s not good for anyone.”