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CMS announces five-star rating for Hospital Compare

Yesterday, CMS officially unveiled the star ratings on its Hospital Compare website in an effort to make it easier for consumers to choose a hospital and understand the quality of care each delivers.

After the new rating system went into effect, only 251 out of approximately 3,300 hospitals have all five stars. The Hospital Compare site notes that a hospital with a one-star rating doesn’t indicate a consumer will receive poor care and encourages consumers to consider multiple factors when choosing hospitals, rather than focusing solely on the star rating.

CMS levies heavy fines on Medicare Advantage plans

The CMS has fined 12 Medicare Advantage plans nearly $4 million in civil money penalties (CMP) since the beginning of the year. Nearly all of the plans were cited for failing to comply with contract requirements, such as incorrect prescription information or coverage disputes.

CMPs are the lowest enforcement penalty the CMS orders, although the financial penalties can be steep. Penalties issued so far range from approximately $21,000 to $1 million. The highest penalty is plan termination.

Additionally, CMS ordered one plan to suspend enrollment and three plans were released from sanctions after correcting deficiencies.

CMS to add five-star rating to Hospital Compare website

The Centers for Medicare & Medicaid Services (CMS) will add the five-star quality rating to its Hospital Compare website later this month. The five-star quality rating is already used on the Nursing Home Compare and Physician Compare sites.

CMS will add twelve HCAHPS Star Ratings to the Hospital Compare; one for each of the 11 publicly reported measures, plus an overall Summary Star Rating that represents a weighted average of the individual HCAHPS Star Ratings.

According to CMS, the star ratings will make it easier for consumers to use the information on the Compare websites and spotlight excellence in healthcare quality.

CMS releases final hospital/CAH CoPs

Last week, the Centers for Medicare and Medicaid Services (CMS) posted the final rule reforming the Hospital/CAH CoPs. This rule is available on display copy only and will publish officially to the Federal Register on May 16th.  The DC office is in the process of completing a thorough review of the final rule and will pull a team together to discuss the provisions, and will provide a comparative analysis of the final provisions to the comments that Joint Commission submitted.

A quick review of the final rule can be found here.

HHS seeks to reduce preterm births with $40m grant incentive

Last week the Department of Health and Human Services (HHS) launched a $40 million effort to reduce preterm births and ensure more babies are born healthy. Through a program called the Strong Start initiative, the Centers for Medicare and Medicaid Services (CMS) will seek to reduce preterm births by awarding grants to hospitals, healthcare providers, and community coalitions to improve prenatal care, test new methods to reverse the trend, and reduce early elective deliveries.

According to HHS, about 10 percent of all deliveries are scheduled—either as induced or Cesarean-section— before 39 weeks and are not medically indicated.

Testing for early induction of labor is addressed in the Joint Commission’s latest National Patient Safety Goal aimed at minimizing overuse of tests, treatments, and procedures in hopes to prevent harm and reduce waste. The idea is that if evidence shows no benefit, you are exposing a patient to only potential harm by giving an unnecessary test or treatment.

In fact, evidence shows the opposite. The American College of Obstetricians and Gynecologists says preterm babies (those born before 39 weeks) are at an increased risk of significant complications such as low birth weight, lung disorders, feeding problems, and blood infections, as well as long-term health problems, and an article released by Kaiser Health News said Medicaid spends $20,000 a year on babies born premature in their first year, almost 10 times that of infants born at full term.

A report by HealthLeader’s Media says reducing early elective births could save $1 billion annually, and according to a survey by The Leapfrog Group, of the 757 hospitals that volunteer to report data on obstetric care quality, too many have obstetricians who still schedule potentially harmful elective Cesareans and inductions too early rather than supporting unprompted deliveries.

To learn more about the effort to reduce preterm births, visit the CMS Innovation website.

HHS encourages equal visitation and representation rights

The Department of Health and Human Services (HHS) issued a press release this week to give added support to The Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (COP) rules released in November of last year giving patients the right to choose their own visitors during a hospital stay.

The guidance given by the HHS emphasizes that hospitals should respect patients’ wishes concerning their representatives (whether expressed in writing, orally, or through other evidence unless prohibited by state law) in an effort to make it easier for family members, including a same-sex domestic partner, to make informed care decisions for loved ones who are incapacitated.

The CMS also sent a letter this week to State Survey Agencies (SSAs), highlighting the equal visitation and representation rights requirements and directing SSAs to be aware of the guidance when surveying for hospitals’ compliance with CoPs.

Read the full press release here.

Latest Sentinel Event Alert:Radiation risks of diagnostic imaging

The Joint Commission released its latest Sentinel Event Alert this morning highlighting the need for healthcare facilities and staff to maintain radiation doses as low as possible during diagnostic imaging in order to decrease exposure to repeat doses. The Alert asks healthcare organizations to address contributing factors to eliminate avoidable exposure by weighing the medical necessity of a given level of radiation against the risks.

According to the Alert, the US population’s total radiation exposure has nearly doubled over the past two decades, and  studies have estimated that 29,000 future cancers and 14,500 future deaths could develop due to radiation from the 72 million CT scans performed in the US in 2007.

In response, the Centers for Medicare & Medicaid Services (CMS) will require accreditation of all facilities providing advanced imaging services (CT scans, MRI, PET, nuclear medicine) including non-hospital, freestanding settings beginning January 1, 2012. The state of California is also requiring facilities that furnish CT X-ray services to become accredited by July 1, 2013.

The Joint Commission gives some suggested actions leaders can take to raise awareness among staff and patients of the risk associated with aggregate radiation doses and provide proper testing and dosage through effective processes, safe technology, and a culture of safety.

Click here to download the Sentinel Event Alert and the full list of recommendations.

HHS aims to improve health and cost for dual eligible patients

The U.S. Department of Health and Human Services (HHS) has introduced three new initiatives to help states lower the cost of healthcare for patients with dual eligibility for both Medicare and Medicaid, as well as reduce hospitalization for this group.

The three separate proposals include:

  • A demonstration program to test two new financial models in hopes to better coordinate care for individuals enrolled in Medicare and Medicaid
  • A demonstration program aimed at helping states improve the quality of care for people in nursing homes in order to reduce hospitalizations
  • Creating a technical resource center to help states improve care for high-need high-cost beneficiaries

The dual eligible population is represented by approximately nine million Americans, and accounts for more than $300 billion in state and federal healthcare spending every year.

The idea is that these initiatives will bring better care coordination and for this population, which in turn will improve the health of dual eligible beneficiaries making them less frequent consumers of healthcare services in general.

Source: Healthcare Finance News

CMS proposes new rule for community mental health centers

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would provide conditions of participation for community mental health centers (CMHCs).

Medicare beneficiaries who receive care from a CMHC have an alternative to inpatient treatment, and are provided with partial hospitalization services, including physician services, psychiatric nursing, counseling, and other social services.

CMS’ new rule includes the following standards:

• Establishing qualifications for CMHC employees and contractors.
• Mandating CMHCs to notify clients of their rights and to investigate and report violations of client rights. These proposed requirements also promote continuity of care by highlighting the need for communication of client needs when they are discharged or transferred.
• Organizing a treatment team, developing an active treatment plan, and coordinating services to ensure an interdisciplinary approach to individualized client care.
• Creating a Quality Assessment and Performance Improvement (QAPI) program. This will require CMHCs to identify program needs by evaluating outcome and client satisfaction data and making changes based on that data to improve their quality of care.
• Put into place organization, governance, administration of services, and partial hospitalization services requirements, with special attention to governance structure.

CMS is accepting comments until August 16, 2011. If you’d like to submit one, visit http://www.regulations.gov and search for rule “CMS-3202-P.”

To view the press release, click here.

CMS proposes new rule: Perform well, be rewarded

The Centers for Medicare & Medicaid Services (CMS) has announced a new rule for hospital inpatient value-based purchasing that plans to give monetary incentive for hospitals to meeting and exceed quality and safety measures, and is also intended to make care safer by reducing medical errors.

Under the program, hospitals that do well both in terms of quality of care and the patient experience – or hospitals that have made improvements in their delivery of care – would be rewarded with higher payments. And, the higher a hospital’s performance or improvement during the performance period during any given fiscal year, the higher the hospital’s value based incentive payment.

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