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Share the trials and tribulations of eCQM success

Are you wondering how you’ll ever be prepared for the CMS’ updated Electronic Clinical Quality Measures (eCQM) due for release February 28, 2017? Don’t worry, you don’t have to face it alone.

The Joint Commission recently unveiled its Core Measure Solution Exchange®, which allows hospitals to share how they implemented the eCQMs. Users can post about the implementation issues they’ve had, challenges they’ve faced, and solutions they’ve come up with. They can learn from other facilities about the problems and solutions they came up with as well.

The Exchange is free and is part of your facility’s Joint Commission Connect extranet. There is already an eCQM solution posted by Wooster Community Hospital for viewing.

CMS to save millions by increasing hospital readmission fines

CMS LogoWith spending on inpatient hospital services expected to increase by $746 million next year, CMS is in need of new ways to save and raise revenue. On August 2, the agency announced a change that will help ease some of its money woes.

At the beginning of the 2017 fiscal year in October, CMS will add new criteria to the Hospital Readmissions Reduction Program that’s expected to save CMS $538 million; $108 million over the previous fiscal year. The new criteria will increase the number of hospitals that are penalized for high readmission rates, as well as the amount for which they are penalized.

CMS has added coronary artery bypass grafts as a surgery for which hospitals can receive a readmission penalty, as well as alter how it calculates readmissions for pneumonia. Other readmission penalty procedures include heart failure, heart attacks, chronic obstructive pulmonary disease, and hip and knee replacements. It’s estimated that 2,588 hospitals will be fined next year due to the update, losing 0.73% of their Medicare payments on average. Only 49 hospitals are expected to receive the maximum penalty of 3% according toKaiser Health News.

Readmissions have been a major point of contention between hospital groups and CMS. Many argue that since CMS’ program doesn’t take socioeconomic factors into account, hospitals that serve poorer or sicker patients are disproportionately fined for high readmissions.

“We are disappointed CMS missed another opportunity to adjust for the social and economic challenges of vulnerable patients in its quality improvement and reporting programs,” said Beth Feldpush, senior vice president at America’s Essential Hospitals, in a statement. “The evidence is clear that these programs disproportionately penalize hospitals that serve disadvantaged patients and communities.”

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HFAP releases prepublication standards manual

HFAP this week released its prepublication manual for acute care hospitals, critical access hospitals, and ambulatory surgical center surveys. The manual has been changed to include requirements of the 2012 Life Safety Code® (LSC), which was recently adopted by CMS. U The CMS adoption of the 2012 LSC went into effect in July, and the new requirements will go into effect for HFAP facilities on November 1, 2016.

The changes to the accreditation requirements are in Chapters 9, 11, and 13 of the manual and can be read here.

Hospital star ratings now online despite Congressional and hospital group efforts

Yesterday, CMS publicly released its hospital star ratings system on its Hospital Compare website. The rankings are meant to provide patients with more transparency on hospital quality.CMS Logo

The release comes one day after Congress announced a bill that, if passed, would have delayed the release for a full year. The bill would have also have required third-party verification of CMS’ data and methodology, which has been a major point of contention for opponents.

Get more details on the CMS decision at HealthLeaders Media.

Congress proposes delaying CMS star ratings for a year

Congress introduced a new bill yesterday that would force CMS to delay the release of its hospital star rating system by a year. The bill, the Hospital Quality Rating Transparency Act of 2016, would also require that a third party analyze CMS’ methodology and data and provide a 60-day comment period for interested parties.

The star ratings are determined by 62 quality measurements and are meant to be a simple, comprehensive look at hospital quality to help consumers make their medical choices. The ratings have come under fire by several hospital organizations who say that the ratings don’t show true quality and that the methodology CMS uses is flawed. One of these groups, the American Hospital Association, applauded Congress’s efforts to delay the ratings.

“Hospitals and members of Congress are in agreement: CMS can do better,” they wrote. “The majority of Congress—60 members of the Senate and more than 225 members of the House—asked CMS to delay and improve upon the star ratings. Our own analysis of preliminary data continues to raise questions and concerns about the methodology, which may unfairly penalize teaching hospitals and those serving the poor.

“We continue to urge CMS to work with hospitals and health systems to provide patients with a rating system that accurately reflects the quality of care provided at their facilities, and will work with Reps. [James] Renacci [R-OH] and [Kathleen] Rice [D-NY] to move this legislation forward.”

CMS: 2% of hospitals earn a “five star” rating

rating-153609_1280 The agency says it will be posting those ratings on its Hospital Compare site “shortly.” Out of 4,599 hospitals previewed:
• 2.2% will receive 5 stars
• 20.3% will receive 4 stars
• 38.5% will receive 3 stars
• 15.7% will receive 2 stars
• 2.9% will receive 1 star
The remaining 20.4% didn’t meet the minimum measure/group reporting thresholds set forth in the Star Ratings Methodology Report and are unrated.
The star ratings are meant to be a simple, comprehensive look at hospital quality to help consumers make their medical choices. The ratings have come under fire by several hospital organizations who say that the ratings don’t show true quality and that the methodology it uses is flawed.

Joint Commission’s 2017 antibiotic stewardship standards

In the wake of a CMS ruling that will make antibiotic stewardship programs (ASP) mandatory, The Joint Commission recently announced that it will roll out a similar standard. Effective January 1, 2017, the new Medication Management standard requires facilities to create an effective ASP. The standard applies to:

The Joint Commission released the standard a month after attending the White House Forum on Antibiotic Stewardship, which focused on implementing changes over the next five years to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, promote stewardship of existing antibiotics, and prevent the spread of resistant infections. Representatives from 150 retailers, food organizations, healthcare organizations, and animal health organizations were in attendance.

Only 40% of U.S. hospitals have an antibiotic stewardship program and an estimated 30% to 50% of prescribed antibiotics are unnecessary or inappropriate.  In the U.S., drug-resistant diseases cause 23,000 deaths and 2 million illnesses each year. That number is expected to increase exponentially in the upcoming decades. 

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CMS begins oncology bundles

On July 1, nearly 200 group practices began a five-year demonstration program of CMS’s. The model’s goal is to improve the quality and decrease the costs of cancer care nationwide. Cancer is the second leading cause of death in America, with 22.5% of all deaths in 2014 resulting from some form of it. Meanwhile, the costs of cancer care are expected to rise to $158 billion in 2020, an increase of 27% over 2010.

“The Oncology Care Model encourages greater collaboration and information sharing so that cancer patients get the care they need,” said U.S. Department of Health and Human Services Secretary Sylvia M. Burwell, in an announcement. “This patient-centered care model furthers the goal of the Vice President’s Cancer Moonshot to improve coordination, care, and outcomes while spending dollars more wisely.”CMS Logo

Participating physicians will receive performance-based payments for caring for Medicare cancer patients under a bundled payment model. They’ll also receive a monthly care management payment for each beneficiary. Participating in the Oncology Care Model is 17 health insurance companies, more than 3,200 oncologists, and approximately 155,000 Medicare beneficiaries. The group practices involved will all follow nationally recognized clinical guidelines for chemotherapy, with improved services including: [more]

U.S. House passes mental health bill

On June 6, the House of Representatives passed the “Helping Families in Mental Health Crisis Act” by a 442-2 vote. The bill would allow CMS to reimburse providers for treating Medicaid patients’ mental health and physical health on the same day, increase the number of psychiatric hospital beds, and cut CMS spending by $5 million over 10 years. The bill was created and led by Rep. Tim Murphy, a licensed child psychologist, in response to the Sandy Hook shootings.

“This historic vote closes a tragic chapter in our nation’s treatment of serious mental illness and welcomes a new dawn of help and hope,” he said in a press release. “We are ending the era of stigma. Mental illness is no longer a joke, considered a moral defect and a reason to throw people in jail.”

The Senate is expected to vote on the bill by the end of the year.


CMS releases list of proposed rules, makes antibiotic stewardship mandatory

Last week, CMS published a list of proposed rule changes for hospitals and laboratories.  One of the more notable proposals would make antibiotic stewardship programs [ASP] mandatory. ASPs are viewed by many as a way to prevent antibiotic misuse and the spread of drug-resistant disease.

CMS Logo

“We propose to change the introductory paragraph [in Infection Control Condition of Participation §482.42] to require that a hospital’s infection prevention and control and antibiotic stewardship programs be active and hospitalwide for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship,” according to the proposed rule.

Only 40% of U.S. hospitals have an antibiotic stewardship program and an estimated 30% to 50% of prescribed antibiotics are unnecessary or inappropriate.  In the U.S., drug-resistant diseases cause 23,000 deaths and 2 million illnesses each year.

The document also changed included changes to patient rights, restraint usage, physician assistants, medical records, diet orders, periodic evaluations, and several more. To see the full list of changes, click here.

Healthcare professionals can comment on the proposed rules until 5 p.m. on August 15, 2016. Comments can be sent by traditional mail to CMS or done online.