In a move that has angered some quality improvement advocates, the CMS revealed that critical-access hospitalsthe often-rural facilities with 25 or fewer inpatient bedswould be excluded from a national quality reporting initiative that ties participation to Medicare reimbursement.
Under the terms of the Hospital Outpatient Quality Data Reporting Program, hospital outpatient departments are required to report on seven mostly heart attack-related clinical measures, beginning in April.
While the program is voluntary, those hospitals that dont participate are automatically docked 2% of their annual outpatient update starting in 2009.
Tim Size, executive director of the Rural Wisconsin Health Cooperative, railed against the CMS decision, saying that it sends the wrong message to those hospitals within the rural health community that have put an emphasis on quality improvement.
Those of us in the rural health community and those of us supporting the quality movement have done everything we can to encourage critical-access hospitals to report, he said. All of the sudden, with no warning, its announced that only critical-access hospitals are prohibited from participating.
Its exactly the wrong message, he said. Its basically them saying that rural hospitals and rural health dont matter.
One obstacle to participation, however, could be that critical-access hospitals are paid based on costs rather than on the inpatient or outpatient prospective payment systems. Still, nearly half of the roughly 1,200 critical-access hospitals participate in an inpatient quality reporting program, providing data to CMSs Hospital Compare Web site, said Nancy Foster, vice president for quality and patient-safety policy at the American Hospital Association. Foster said that the AHA is working closely with the CMS to find ways for critical-access hospitals to participate on the outpatient side as well.
Thats particularly true for the heart attack measures, because the measures were specifically crafted to enable smaller hospitals that tend to stabilize and transfer many, if not all, the heart attack patients they receive to larger hospitals that have equipment and personnel that the smaller one may not, she said. -- by Matthew DoBias
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