A proposed Medicare rule that would tie hospital outpatient payments to a new quality reporting initiative is being called too much, too soon, by the nations largest hospital association.
Nancy Foster, vice president of quality and patient safety at the American Hospital Association, said that while the AHA likes the initiative, it nevertheless is wary that the CMS timeframe may be unrealistic for some small and rural hospitals.
The initiative is important for two reasons, Foster said. One, it moves us out of the inpatient area and into public reporting on a broader array of care. And, it is important because the measures theyve labeled as emergency department measuresheart-attack transfer patientswill be very important for the smaller hospitals that tend to stabilize and transfer their heart attack patients.
Nevertheless, hospitals would need more time to get ready for the changeover, and would prefer it be implemented a few months later than planned, she said.
In its proposed hospital outpatient prospective payment system rule, the CMS said that it would require outpatient departments to report on quality data starting Jan. 1, 2008, or otherwise be penalized with a 2% reduction in Medicare payments. Called the Hospital Outpatient Quality Data Reporting Program, or HOP-QDRP, the CMS anticipates that more measures will come in the next couple of years, with another 30 being singled out for comments.
In the rule, the CMS said that it expects the program to not only improve health outcomes for Medicare beneficiaries, but also to fuel overall hospital efficiency.
In the short term, however, outpatient departments are being asked to report on 10 quality measures, the first five of which deal closely with adult heart attack patients in the emergency department. Those five measures are in line with the National Quality Forums reporting program.
Additionally, the CMS proposed five more measures, including one related to the treatment of heart failure; two related to surgical-care improvement; one that addresses treatment of community-acquired pneumonia; and another related to diabetes care.
The CMS is refining the measures and expects to release the final specifications later this fall. The agency also expects to submit the measures for NQF endorsement.
But the lack of full NQF endorsement of all of the measures is another sticking point, Foster said. Its fair to say that well emphasize the need for measures to be endorsed by NQF and accepted by the Hospital Quality Alliance, which has so far offered only a preliminary endorsement, she said.
Forrest Calico, senior advisor on quality for the National Rural Health Association, said while he supports the measures, he nevertheless would like to see the CMS use carrots rather than sticks to encourage hospitals to report.
In terms of the way CMS handles it, theres always the potential they might be punitive towards people who might not have the capacity to do it by their deadline, Calico said.