IPPS Proposed Rule Adds Readmission Measures, HAC Timeline

Cheryl Clark, for HealthLeaders Media , April 29, 2013

For the first time, the algorithm includes three measures of 30-day mortality, weighted at 25% of the VBP algorithm. Patient experience scores as measured by the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey remains at 30% and clinical processes of care, the remaining 45%.

FY 2015 Hospital-Acquired Conditions Penalty and timeline
The proposed rule lays out the ground rules for a new penalty program for the 25% of hospitals that have the highest number of eight hospital-acquired conditions, as measured over a two-year period beginning July 1, 2011. The penalty would kick in with payments for care, next year, as of Oct. 1, 2014.

The HAC penalty is mandated by the PPACA.

These eight conditions would be divided between two domains, and risk-adjusted for hospital's patient severity mix. The first domain would include six patient safety indicator measures developed by the Agency for Health Care Research and Quality (AHRQ). They are:

  1. Rates of pressure ulcers
  2. Number (not rate) of foreign surgical objects left inside patients
  3. Rate of iatrogenic pneumothorax
  4. Rate of postoperative physiologic and metabolic derangement (signs of uncontrolled blood sugar)
  5. Rate of post-operative pulmonary embolism or deep vein thrombosis
  6. Rate of accidental puncture and laceration

The second domain would include two healthcare associated infection measures. They are:

  1. Rates of central line-associated bloodstream infections
  2. Rates of catheter-associated urinary tract infections.

Each domain would be weighted 50% for a penalty that would amount to 1% of a hospital's Medicare base DRG payment.

Disproportionate share hospitals
As expected, CMS proposes to dramatically cut pay for hospitals that previously received disproportionate share funds for taking care of larger numbers of uninsured or underinsured. "Hospitals will receive 25% of their current Medicare DSH payments beginning in FY 2014," the agency said in a news release.

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