Transcript HFMA's Regulatory Sound Bites: An Overview of the FY13

HFMA’s Regulatory Sound Bites
An Overview of the Final 2013 Inpatient Prospective Payment Rule
Dear Member,
This presentation provides a summary of recent regulatory acts and
highlights the features that most affect acute care hospitals. It also offers a
guide to HFMA resources you can use to navigate your organization
through the complicated economic and regulatory environment.
Please feel free to use this presentation to educate your staff and other
hospital stakeholders. If HFMA can be of additional assistance in any way,
please do not hesitate to contact us.
Warmest Regards,
HFMA
Presentation Objectives
Review the 2013 Final Medicare
Inpatient Prospective Payment Rule
Analyze Implications for Hospitals
Identify HFMA Resources for
Addressing These Changes
1
Positive Impact
The Final Rule Increases Payments to All Hospitals
Reimbursement Impact of the 2013
Final IPPS Rule
Teaching Status
Geographic Area
3%
2.30%
2.50%
2.60%
2.50%
2.40%
2.30%
2%
0.30%
0.20%
Rural Areas
Non-Teaching
1%
0%
<= 100 Residents
> 100 Residents
Other Urban Areas
Large Urban Areas
Urban
-2%
All Hospitals
-1%
Source, pp. http://www.ofr.gov/OFRUpload/OFRData/2012-19079_PI.pdf pgs 1881-1886
2
Operating Base Rates
CMS Is Adjusting the Market-Basket Update for Upcoding Related to MS-DRG Implementation
IPPS Provisions
• The 2013 final MBU is
 2.6% for hospitals submitting quality data
 0.2% for hospitals not submitting quality data
• The market basket rate-of-increase
of 2.6% will be reduced further by an
adjustment of 0.7% for the
multifactor productivity adjustment,
less 0.1% (both mandated by the
ACA), resulting in a net payment
increase of 1.8 percent.
Implications for Hospitals
• The rate increase will increase hospital
payments by an estimated $2.0 billion in
FY13, or 2.3 percent.
• Additional reductions are anticipated.
Providers should look for opportunities to
reduce waste inefficiencies.
Notes:
1. See Appendix 1 for final operating rates
3
Capital Base Rates and Payments
Capital Payments Are Increased by an Estimated 1.2%
IPPS Provisions
• CMS establishing an update of 1.2% in
determining the FY13 capital federal rate
for all hospitals
• CMS not adopting proposal to make an
additional -0.8% adjustment to the
national capital rate in FY13 to adjust for
upcoding as a result of MS-DRG
implementation
Implications for Hospitals
• Additional negative adjustments for
documentation and coding should
be anticipated
• Capital rate established at $425.49 for
FY13, based on 1.2 % update and other
budget neutrality factors
Notes:
1. See Appendix 2 for calculation of FY13 standard federal capital rates
4
Outlier Payments
•
The final outlier fixed-loss cost threshold for FY13 will decrease to $21,821, from
the current amount of $23,630.
•
CMS using same methodology it proposed to calculate the outlier threshold for
FY13, using cases from the FY11 MedPAR file (the most recent data available at
the time of this final rule)
•
Hospital VBP and readmissions payment adjustments excluded from this
calculation
•
For FY13, a case would qualify as a cost outlier if the cost for the case plus the
(operating) IME and DSH payments is greater than the prospective payment rate
for the MS-DRG, plus the fixed loss amount of $21,821
•
Facilities need to model these changes to understand the full financial impact on
revenue
5
Quality Data for Payment Update
• For FY14, CMS suspended data collection for four measures beginning with
January 1, 2012, discharges, affecting the FY14 payment determination and
subsequent years
• These measures include:
Acute Myocardial Infarction (AMI)
o AMI-1 Aspirin at arrival
o AMI-3 ACEI/ARB for left ventricular systolic dysfunction
o AMI-5 Beta-blocker prescribed at discharge
 Surgical Care Improvement Project (SCIP)
o SCIP INF-6 Appropriate Hair Removal
• CMS says the suspension of data collection for these four measures will be
continued unless it has evidence that performance on the measures is in danger of
declining
6
Quality Data for Payment Update
The rule finalizes a total of 59 measures for FY15 and subsequent years
IPPS Provisions
• For FY15 CMS adopting all Hospital IQR
Program measures adopted in previous
payment determinations, with the exception of
the 17 measures
 Measures that CMS is removing include:
1 chart-abstracted measure
16 claims-based measures
Implications for Hospitals
• Providers should make sure they can collect
and submit the additional quality measures
• Processes should be in place to improve
performance for each measure
• For FY15, and subsequent years, the 59
measures that CMS is finalizing include:
 New survey-based measure items for
inclusion in the HCAHPS survey
measure
 3 claims-based measures
 1 chart-abstracted measure
• Total of 59 measures for the FY15 payment
determination and subsequent years
Notes:
See Appendix 3 for FY15 Hospital IQR quality measures
7
Quality Data for Payment Update
Additional IQR Program Measures for FY15
IQR Program Measures for the FY16
• HCAHPS survey measure: NQF-endorsed 3-Item
Care Transition Measure (CTM-3) (NQF #0228)
• CMS adopted the Safe Surgery Checklist
Use measure for FY16
• Three claims-based measures:
• not NQF-endorsed
 Hip/Knee Complication: Hospital-level riskstandardized complication rate (RSCR)
following elective primary total hip
arthroplasty (THA) and total knee
arthroplasty (TKA) (NQF#1550)
 Hip/Knee Readmission: Hospital-Level 30Day All-Cause Risk-Standardized
Readmission Rate (RSRR) Following
Elective Total Hip Arthroplasty (THA) and
Total Knee Arthroplasty (TKA) (NQF
#1551)
• Structural measure assesses whether a
hospital outpatient department utilizes a
Safe Surgery checklist that assesses
whether effective communication and safe
practices are performed during three
distinct perioperative periods:
 Hospital-Wide Readmission (tentative NQF
#1789)
 prior to the administration of
anesthesia
 prior to skin incision
 period of closure of incision and
prior to the patient leaving
operating room
• New Chart-Abstracted Measure: Elective
Delivery Prior to 39 Completed Weeks Gestation:
Percentage of babies electively delivered prior to 39
completed weeks gestation (NQF #0469)
• CMS is finalizing the Safe Surgery Checklist
use measure for a total of 60 measures for
the FY 2016 payment determination and
subsequent years. .
8
Wage Index
IPPS Provisions
• For FY13, the wage index will continue to be
calculated and assigned to hospitals on the
basis of the labor market area in which the
hospital is located
• CMS defines hospital labor market areas
based on the Core-Based Statistical Areas
(CBSAs)
 The FY13 wage index values are
based on the data collected from
the Medicare cost reports
submitted by hospitals for cost
reporting periods beginning in
FY09 (the FY12 wage indices
were based on data from cost
reporting periods beginning
during FY08)
Implications for Hospitals
• Providers should complete the
occupational mix index survey
 In the FY11 IPPS/LTCH PPS
proposed rule and final rule,
beginning with the new 2010
occupational mix survey, CMS
required hospitals that do not submit
occupational mix data to provide an
explanation for not complying.
CMS instructed FIs/MACs to begin
gathering this information as part of
the FY13 wage index desk review
process. CMS will review these data
for future analysis and consideration
of potential penalties for
noncompliant hospitals.
• The FY13 national average hourly wage
(unadjusted for occupational mix) is
$37.4855
9
Hospital Readmissions Reduction
IPPS Provisions
• The Hospital Readmissions Reduction Program requires
a reduction to a hospital’s base operating DRG
payment amount to account for excess readmissions of
selected applicable conditions:
 acute myocardial infarction
 heart failure
 pneumonia
Implications for Hospitals
• Hospitals should work to
understand the readmission drivers
within their patient population and
put programs in place to mitigate
these issues.
• Minimum number of discharges for each applicable
conditions is 25
• Provision not budget neutral
• For FY13, readmission payment adjustment is the
higher of ratio of a hospital’s aggregate dollars for
excess readmissions to their aggregate dollars for all
discharges, or 0.99 (that is, or a 1-percent reduction)
• Program will result in an estimated 0.3 percent
decrease, or $280 million, in payments to hospitals
• Secretary can expand the conditions for the program in
FY15
• CMS finalized 3 years (7/1/08 to 6/30/11) as the
applicable period for the FY13 payment adjustment
10
Value Based Purchasing
• Under Hospital Value-based Purchasing Program (VBP), value-based incentive payments
are made in a fiscal year to hospitals that meet performance standards established for a
performance period for such fiscal year.
•
ACA directs the Secretary to begin making value-based incentive payments under the
Hospital Inpatient VBP Program for discharges occurring on or after October 1, 2012.
•
Incentive payments will be funded for FY13 through a reduction to the FY13 base
operating MS-DRG payment for each applicable hospital’s discharge of 1%.
The applicable percentage for FY14 is 1.25%
 The applicable percentage for FY15 is 1.5%
 The applicable percentage for FY16 is 1.75%
 The applicable percentage for FY17 and subsequent years is 2%
•
For the FY13 Hospital VBP Program, CMS previously adopted 13 measures, including 12
clinical process of care measures and a 13th measure comprising 8 dimensions from the
Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS).
The 13 measures were categorized into two domains.
11
Value Based Purchasing
• CMS grouped the 12 clinical process of care measures into a Clinical Process of Care domain, and placed
the HCAHPS survey measure into a Patient Experience of Care domain.
• CMS adopted a 3-quarter performance period from July 1, 2011, through March 31, 2012, for these
measures and performance standards on which hospital performance will be evaluated.
• To determine whether a hospital meets or exceeds the performance standards for these measures, CMS
will assess each hospital’s achievement and improvement during the period as compared with its
performance during a 3-quarter baseline period from July 1, 2009, through March 31, 2010.
• CMS will then calculate a total performance score (TPS) for each hospital by combining the greater of
the hospital’s achievement or improvement points for each measure to determine a score for each
domain, weighting each domain score.
 For the FY13 Hospital VBP Program, the weights will be clinical process of care = 70 percent,
patient experience of care = 30 percent. The weighted domain scores will be added together.
• CMS will convert each hospital’s TPS into a value-based incentive payment percentage using a linear
exchange function and then convert the value-based incentive payment percentage into a per
discharge value-based incentive payment amount.
12
Value Based Purchasing
• For FY14, CMS has adopted 17 measures for the Hospital VBP Program, including:
 12 clinical process of care measures from FY13 Hospital VBP Program and the
HCAHPS measure adopted for the FY13 Hospital VBP Program
 1 new clinical process of care measure (SCIP-Inf-9: Postoperative Urinary Catheter
Removal on Postoperative Day 1 or 2)
 3 mortality outcome measures (Acute Myocardial Infarction (AMI) 30-Day Mortality
Rate, Heart Failure (HF) 30-Day Mortality Rate, Pneumonia (PN) 30-Day Mortality
Rate)
• Although CMS previously adopted 8 HAC measures, 2 AHRQ composite measures, and a
Medicare Spending Per Beneficiary Measure for the FY14 Hospital VBP Program, it has
suspended the effective date of these measures, with the result that they will not be
included
Notes:
See Appendix 4 for FY14 VBP Measures
13
Value Based Purchasing
• For FY15, CMS will retain 12 of the 13 clinical process of care measures it adopted for the FY14 program
 CMS finalizing proposal to remove SCIP-Inf-10: Surgery Patients with Perioperative Temperature Management
from the FY15 Hospital VBP Program because it is “topped-out”
 SCIP-VTE-1 removed from the Hospital VBP Program measure set beginning with the FY15 Hospital VBP
Program
• AMI-10 not finalized for FY15 Hospital VBP Program measure because it meets CMS definition of “topped-out”
• For patient experience of care domain, CMS will retain eight dimensions of the HCAHPS survey adopted for FY13 and
FY14 Hospital VBP Program
• For the outcome domain, CMS retains the three 30-day mortality measures finalized for the FY14 Hospital VBP Program
•Adopts two additional outcome measures for the Outcome domain
 PSI-90, the AHRQ PSI composite measure
 CLABSI: Central Line-Associated Blood Stream Infection measure
• For Efficiency domain, CMS adopts one new measure:
 Medicare Spending per Beneficiary measure
Notes:
See Appendix 5 for FY15 VBP measures (please note that although AMI-10 is not finalized for FY15, it
appears in the list of measures published in the final rule, which also appears in the appendix)
14
Value Based Purchasing
• CMS is not finalizing the proposal to reclassify the Hospital VBP measures into domains
based on the six priorities of the National Quality Strategy in FY16. It will maintain the
existing four-domain structure.
• Will include the 30-day mortality measures, AHRQ PSI composite measure, and other
measures finalized for the FY15 Hospital VBP measure set (with the exception of the
CLABSI measure) in the FY16 measure set.
Note: See Appendix 6 for FY15 data collection period and performance standards
15
Disproportionate Share
IPPS Provisions
• CMS will adopt a policy that hospitals
that are required to submit no pay
bills for services furnished on a
prepaid capitation basis by a
Medicare Advantage organization, or
through cost settlement with an HMO,
a competitive medical plan (CMP), a
health care prepayment plan (HCPP),
or a demonstration, for the purpose
of calculating the DSH patient
percentage (DPP), must also do so
within the time limits for filing claims
specified at § 424.44
Implications for Hospitals
• Hospitals submitting claims
for services provided to
Medicare Advantage enrollees
for additional IME and direct
GME payments, and for
claims for nursing or allied
health education program
payments, must ensure that
they comply with the
regulations governing time
limits for filing claims at §
424.44
 Under §424.44, time limits for
filing claims, for services
furnished on or after January 1,
2010, the claim must be filed no
later than the close of the period
ending 1 calendar year after the
date of service
16
Disproportionate Share
Policy Change Relating to Treatment of Labor and Delivery Beds in the Calculation of the Medicare DSH
Payment Adjustment and the IME Payment Adjustment
• Under current policy, services furnished to a labor and delivery patient are considered to be
generally payable under the IPPS, under § 412.105(b)(4), but beds where the services are
furnished are not available for IPPS-level acute care hospital services
• CMS believes if patient day is counted because the services furnished are generally payable
under the IPPS, the bed in which the services were furnished should be considered available for
IPPS-level acute care hospital services
• CMS believes it is appropriate to extend current approach of including labor and delivery patient
days in the disproportionate patient percentage of the Medicare DSH payment adjustment to
rules for counting hospital beds for purposes of both the IME payment adjustment and the
Medicare DSH payment adjustment
 The rules for counting hospital beds for purposes of the IME payment adjustment are codified in the
IME regulations at § 412.105(b), which are cross-referenced in § 412.106(a)(1)(i) for purposes of
determining the DSH payment adjustment
• CMS revises the regulations at § 412.105(b)(4) to remove from the list of currently excluded
beds those beds associated with ancillary labor/delivery services
• Will negatively impact IME reimbursement
17
IME/GME Payments
IPPS Provisions
• Section 5503 of the ACA added new section
1886(h)(8) to the Act providing reductions in FTE
resident caps for direct GME payment purposes
under Medicare hospitals training fewer residents
than their FTE resident caps, and to authorize a
“redistribution” of the estimated number of
excess FTE resident slots to other qualified
hospitals
Implications for Hospitals
Hospitals that can qualify for additional
slots and can fill them should apply
• This section amended section 1886(d)(5)(B)(v)
of the Act to require application of the provisions
of section 1886(h)(8) of the Act “in the same
manner” to the IME FTE resident caps
• Cap-building period will increase the from 3
years to 5 years
• CMS is also finalizing the proposed methodology
used to calculate a cap adjustment for an
individual hospital if a new program rotates
residents to more than one hospital (or hospitals)
Note:
See Appendix 8 for additional information.
18
IME/GME Payments
•
The methodology is based on the sum of the products of the following three factors:
1. The highest total number of FTE residents trained in any program year, during the
fifth year of the first new program’s existence at all of the hospitals to which the
residents in that program rotate
2. The number of years in which residents are expected to complete the program,
based on the minimum accredited length for each type of program
3. The ratio of the number of FTE residents in the new program that trained at the
hospital over the entire 5-year period to the total number of FTE residents that
trained at all hospitals over the entire 5-year period
•
CMS finalizing policy under section 5503 and revising the regulations text at
§413.79(n)(2)(ii) to state that if a hospital does not use all of its section 5503 cap
award in its final (12-month or partial) cost report of the 5-year period beginning July
1, 2011, and ending June 30, 2016, the applicable unused slots will be removed , and
the award will be reduced for portions of cost reporting periods on or after July 1,
2016.
19
New HACs

The hospital-acquired conditions (HACs) payment policy, mandated by the Deficit Reduction
Act of 2005, prevents hospitals from being paid at higher MS-DRG rate for patients with
complications or major complications if the sole reason for the higher payment is the occurrence,
during the beneficiary’s hospital stay, of one of the conditions on the HACs list.

CMS adding Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) and
Iatrogenic Pneumothorax with Venous Catheterization to the HAC payment provision for FY13.

CMS finalizing its proposal to add Iatrogenic Pneumothorax with Venous Catheterization with the
following diagnosis code 512.1 (Iatrogenic pneumothorax) and procedure code 38.93 (Venous
catheterization NEC).

CMS also adding two codes, 999.32 (Bloodstream infection due to central catheter) and 999.33
(Local infection due to central venous catheter) to the existing Vascular Catheter-Associated
Infection HAC Category for FY13.
 CMS is modifying its proposal to add SSI Following CIED Procedures as a HAC condition. CMS’s final policy
makes SSI following CIED Procedures a sub-HAC condition within the SSI HAC category subject to the HAC
payment provision for discharges occurring on or after October 1, 2012.
20
MDH Program Expiration
 Under Section 3124 of the ACA, Medicare dependent hospitals (MDHs) currently
receive the higher of payments made under the federal standardized amount or
the payments made under the federal standardized amount plus 75 percent of
the difference between the federal standardized amount and the hospitalspecific rate
 Because MDH program is not authorized by statute beyond FY12, beginning in
FY13, all hospitals that previously qualified for MDH status will no longer have
MDH status and will be paid based on the federal rate
 CMS will allow hospitals currently classified as Medicare dependent hospitals
(MDHs) to apply for classification as sole community hospitals (SCHs) upon the
expiration of the MDH program on September 30, 2012
 The SCH status will be effective the day following the expiration of the MDH
program
 CMS believes it is difficult to quantify the payment impact of this policy because
it cannot estimate the number of MDHs that will be applying for SCH status
21
Significant Increases/
Decreases in MS-DRGs
MS-DRG
Description
FY 2012
Weight
FY
Percent
2013
Diff
Weights
682 Renal Failure w MCC
1.641 1.5862
-3.34
872 Septicemia or severe sepsis w/o MV 96+ hours w/o MCC
1.1339 1.0988
-3.1
683 Renal Failure w CC
1.0183 0.9958
-2.21
292 Heart failure & shock w CC
1.0214 1.0034
-1.76
871 Septicemia or severe sepsis w/o MV 96+ hours w MCC
1.909 1.8803
-1.5
1.1485 1.1345
-1.22
310 Cardiac arrhythmia & conduction disorders w/o CC/MCC
0.5608 0.5541
-1.19
191 Chronic obstructive pulmonary disease w CC
0.9628 0.9521
-1.11
309 Cardiac arrhythmia & conduction disorders W CC
0.8155 0.8098
-0.7
378 G.I. hemorrhage w CC
1.0238 1.0168
-0.68
392 Esophagitis, gastroent & misc digest disorders w/o MCC
0.7421 0.7375
-0.62
193 Simple pneumonia & pleurisy w MCC
1.4948 1.4893
-0.37
287 Circulatory disorders except AMI, w card cath w/o MCC
194 Simple pneumonia & pleurisy w CC
1.0743 1.0709
-0.32
1.0026 0.9996
-0.3
192 Chronic obstructive pulmonary disease w/o CC/MCC
0.7081 0.7072
-0.13
65 Intracranial hemorrhage or cerebral infarction w CC
690 Kidney & urinary tract infections w/o MCC
0.781
0.781
247 Perc cardiovasc proc w drug-eluting stent w/o MCC
1.9828 1.9911
470 Major joint replacement or reattachment of lower extremity w/o
MCC
2.0866 2.0953
291 Heart failure & shock w MCC
1.501 1.5174
0
0.42
0.42
1.09
190 Chronic obstructive pulmonary disease w MCC
1.1684
1.186
1.51
312 Syncope & collapse
0.7139 0.7339
2.8
313 Chest pain
0.5434 0.5617
3.36
22
HFMA Resources
Links to HFMA Resources Addressing IPPS-Related Challenges
HFMA provides additional information on the following:
IIPS Final Rule:
HFMA’s Medicare’s Final Inpatient Payment Rule for FY13 Webinar
Larry Goldberg provides commentary on the 2013 final Medicare rule.
Value-Based Purchasing:
Hospital Inpatient Value-Based Purchasing Program Fact Sheet
Discusses the value-based purchasing program, including scoring methodologies, thresholds, benchmark targets, and
measures.
Hospital Readmissions:
Hospital Readmissions Reduction Program Overview
Provides a summary of the various aspects of the Hospital Readmissions Reduction Program.
23
QUESTIONS
For questions regarding this presentation or the final IPPS
Rule, please contact:
Chad Mulvany
Technical Director
HFMA
1825 K Street, NW
Suite 900
Washington, D.C. 20006
Office: 202.238-3453
Email:
[email protected]
24
Appendices
 Appendix I: Final IPPS Base Rates/Standard
Operating Amounts
 Appendix II: Standard Federal Capital Rates
 Appendix III: FY15 Hospital IQR Quality
Measures
 Appendix IV: FY14 VBP Measures
 Appendix V: FY15 VBP Measures
 Appendix VI: FY15 Data Collection Period
 Appendix VII: FY15 Performance Standards
 Appendix VIII: Resident Cap Ranking Criteria
25
Appendix I: Final IPPS Base Rates/Standard
Operating Amounts
National Adjusted Operating Standardized Amounts
(68.8 Percent Labor Share/31.2 Percent Nonlabor if Wage Index Is Greater Than 1)
National Adjusted Operating Standardized Amounts
(62 Percent Labor Share/38 Percent Nonlabor Share
if Wage Index Is Less Than or Equal To 1)
Adjusted Operating Standardized Amounts for Puerto Rico,
Labor/Nonlabor
26
Appendix 2: Final IPPS Base Rate
Standard Federal Capital Rate
27
Appendix 3: FY15 Hospital IQR Quality
Measures
Topic
Hospital IQR Program Measures for FY15 Payment
Determination and Subsequent Years
Acute Myocardial Infarction (AMI) Measures

AMI-2 Aspirin prescribed at discharge

AMI-7a Fibrinolytic (thrombolytic) agent received
within 30 minutes of hospital arrival

AMI-8a Timing of Receipt of Primary Percutaneous
Coronary Intervention (PCI)

AMI-10 Statin Prescribed at Discharge
Heart Failure (HF) Measures

HF-1 Discharge instructions

HF-2 Evaluation of left ventricular systolic function

HF-3 Angiotensin Converting Enzyme Inhibitor
(ACE-I) or Angiotensin II Receptor Blocker (ARB)
for left ventricular systolic dysfunction

STK-1VTE prophylaxis

STK-2 Antithrombotic therapy for ischemic stroke

STK-3 Anticoagulation therapy for Afib/flutter

STK-4 Thrombolytic therapy for acute ischemic
stroke

STK-5 Antithrombotic therapy by the end of
hospital day 2

STK-6 Discharged on Statin

STK-8 Stroke education

STK-10 Assessed for rehab
Stroke (STK) Measure Set
28
Appendix 3 (continued): FY15 Hospital
IQR Quality Measures
Topic
Hospital IQR Program Measures for FY15 Payment
Determination and Subsequent Years
VTE Measure Set




VTE-1 VTE prophylaxis
VTE-2 ICU VTE prophylaxis
VTE-3 VTE patients with anticoagulation overlap
therapy
VTE-4 Patients receiving un-fractionated Heparin
with doses/labs monitored by protocol


VTE-5 VTE discharge instructions
VTE-6 Incidence of potentially preventable VTE

PN-3b Blood culture performed in the emergency
department prior to first antibiotic received in
hospital
PN-6 Appropriate initial antibiotic selection
Pneumonia (PN) Measures

Surgical Care Improvement Project (SCIP) Measures






SCIP INF-1 Prophylactic antibiotic received within 1
hour prior to surgical incision
SCIP INF-2: Prophylactic antibiotic selection for
surgical patients
SCIP INF-3 Prophylactic antibiotics discontinued
within 24 hours after surgery end time (48 hours for
cardiac surgery)
SCIP INF-4: Cardiac surgery patients with controlled
6AM postoperative serum glucose
SCIP INF-9: Postoperative urinary catheter removal
on post operative day 1 or 2 with day of surgery
being day zero
SCIP INF-10: Surgery patients with perioperative
temperature management
29
Appendix 3 (continued): FY15 Hospital
IQR Quality Measures
Topic
Hospital IQR Program Measures for FY15 Payment Determination
and Subsequent Years

SCIP Cardiovascular-2: Surgery Patients on a Beta Blocker
prior to arrival who received a Beta Blocker during the
perioperative period

SCIP-VTE-2: Surgery patients who received appropriate VTE
prophylaxis within 24 hours pre/post surgery
Mortality Measures (Medicare Patients)

Acute Myocardial Infarction (AMI) 30-day mortality rate

Heart Failure (HF) 30-day mortality rate

Pneumonia (PN) 30-day mortality rate
Patients' Experience of Care Measures

HCAHPS survey (expanded to include one 3-item care
transition set* and two new “About You” items)
Readmission Measures (Medicare Patients)

Acute Myocardial Infarction 30-day Risk Standardized
Readmission Measure

Heart Failure 30-day Risk Standardized Readmission Measure

Pneumonia 30-day Risk Standardized Readmission Measure

30-day Risk Standardized Readmission following Total
Hip/Total Knee Arthroplasty*

Hospital-Wide All-Cause Unplanned Readmission (HWR)*
AHRQ Patient Safety Indicators (PSIs) Composite Measures

Complication/patient safety for selected indicators (composite)
AHRQ PSI and Nursing Sensitive Care

PSI-4 Death among surgical inpatients with serious treatable complications
Structural Measures

Participation in a Systematic Database for Cardiac Surgery

Participation in a Systematic Clinical Database Registry for
Stroke Care

Participation in a Systematic Clinical Database Registry for
Nursing Sensitive Care

Participation in a Systematic Clinical Database Registry for
General Surgery
30
Appendix 3 (continued): FY15 Hospital
IQR Quality Measures
Topic
Hospital IQR Program Measures for FY15 Payment Determination and
Subsequent Years
Healthcare-Associated Infections Measures

Central Line Associated Bloodstream Infection

Surgical Site Infection

Catheter-Associated Urinary Tract Infection

MRSA Bacteremia

Clostridium Difficile (C.Diff)

Healthcare Personnel Influenza Vaccination
Surgical Complications

Hip/Knee Complication: Hospital-level Risk-Standardized
Complication Rate (RSCR) following Elective Primary Total Hip
Arthroplasty
Emergency Department (ED)Throughput Measures

ED-1 Median time from emergency department arrival to time of
departure from the emergency room for patients admitted to the
hospital

ED-2 Median time from admit decision to time of departure from the
emergency department for emergency department patients
admitted to the inpatient status
Prevention: Global Immunization (IMM) Measures

Immunization for Influenza

Immunization for Pneumonia

Medicare Spending per Beneficiary
Cost Efficiency
Perinatal Care
Elective delivery prior to 39 completed weeks of gestation
31
Appendix 4: FY14 VBP Measures
32
Appendix 5: FY15 VBP Measures
33
Appendix 6: FY15 Data Collection
Period
34
Appendix 7: FY15 Performance Standards
35
Appendix 8: Resident Cap Ranking
Criteria
36
Appendix 8 (continued): Resident Cap
Ranking Criteria
37