The American Hospital Association is urging the CMS to be lenient with hospitals that are having trouble submitting quality data in exchange for a higher Medicare payment. The CMS, meanwhile, doesn't see much of a problem.
Under last year's Medicare reform law, hospitals that submit data on 10 quality measures for heart attack, heart failure and pneumonia receive a 3.3% increase in their Medicare rates in 2005, an adjustment that reflects the rate of full inflation. Hospitals that do not submit data receive a 2.9% increase.
According to the AHA and others, some 130 hospitals that attempted to submit data have experienced difficulty getting it accepted by the CMS.
"We urge you to ensure that hospitals that have acted in good faith to submit their quality data receive the full marketbasket update," Rick Pollack, the AHA's executive vice president, wrote in an Aug. 16 letter to CMS Administrator Mark McClellan.
The CMS declined last week to disclose how many hospitals have successfully submitted the quality measure reports, which were due Aug. 16. The agency did say that "virtually all hospitals are reporting" and the list of hospitals with data problems is dwindling.
McClellan wasn't ready last week to respond to the AHA's letter, said an agency source who spoke on condition of anonymity.
The source added, "To say there's 130 hospitals out there that won't get money would be wrong."
Earlier this month, the AHA and the Federation of American Hospitals received a list from the CMS of the 130 hospitals having difficulties with data submission. Many of the problems, the AHA said, stemmed from the CMS' "CART" tool, which hospitals use to cull the information for reporting.
The CMS last week would not provide a list of which hospitals struggled to submit their data, and officials from the AHA and the federation said they could not find a hospital willing to comment.
Some hospitals ran into problems when their data did not square with cost reports on file at the CMS. "That has seemingly been worked out," said Nancy Foster, senior associate director of policy at the AHA.
All but 50 to 60 hospitals submitted quality data, she said.
"Because of a lot of hard work that hospital staff, the (quality-improvement organizations) and CMS staff have put in, we believe most if not all the issues present when we received the list have been resolved," Foster said.
Seven hospitals that are members of the federation were identified on the list of 130 with data problems, according to Susan Van Gelder, the federation's corporate secretary and senior vice president of strategic policy.
The CMS is trying not to decline hospitals a full rate update because of a glitch in their data submission, the CMS source said.