New Data from CMS Provides Penalties and Public Accountability
Patient safety has always been of primary importance for the delivery of care for any healthcare provider. Despite the focus on patient well-being, landmark studies have identified lapses in various patient safety procedures across the industry. In an attempt to correct these lapses, CMS created several programs that provide a financial incentive for patient safety in healthcare facilities. Programs from CMS either reduce payments to facilities that don’t meet certain thresholds for patient safety or present measurement information to the public to help the public make informed decisions.
Two recent data releases from CMS have increased the scrutiny on healthcare facilities.
The first is a new release of data regarding the latest measurements under the CMS Hospital Acquired Condition Reduction Program. Under this program, hospitals that perform in the bottom quartile on various quality measures receive a 1% reduction in Medicare payments.
CMS measurements in the program include rates of:
- Bloodstream infections in patients with central lines;
- Surgical-site infections; and
- Urinary tract infections for catheterized patients
- Collapsed lungs;
- Broken hips;
- Infections from colon operations;
- Infections from hysterectomies
- Pressure ulcers
- Reopened wounds
- Surgical tears
In FY 2016, 758 hospitals will be penalized for their high hospital-acquired condition rates. According to CMS, 54% of hospitals that are being penalized in this round of evaluations were also penalized in FY 2015.
The second development is the release of updated data for the CMS Physician Compare and Hospital Compare websites. These sites contain quality measurement data that help the public understand the performance of facilities, physicians and physician groups.
New quality measures have been added to Physician Compare for group practices and Accountable Care Organizations (ACOs) and, for the first time, individual health care professionals. These measures focus on the quality of care provided by Medicare physicians and other health care professionals. Hospital Compare includes information on more than 100 quality measures and over 4,000 hospitals.
The goal of the Physician Compare website is to help consumers make informed choices about the health care they receive from Medicare physicians and other health care professionals.
The new data released for Physician Compare includes:
- Additional performance scores on preventive care, diabetes, cardiovascular care, and patient safety by some group practices.
- New performance scores on patients’ experiences with some group practices.
- First set of individual health care professional performance scores on preventive care, cardiovascular care, and patient safety measures.
- Updated performance scores for ACOs.
The goal of Hospital Compare is to inform patients about hospital quality and to encourage care improvements on the hospital level. Hospital Compare allows patients and family members to simultaneously compare multiple hospitals on their performance related to heart attack, heart failure, pneumonia, surgery, and other conditions.
The new data released for Hospital Compare include:
- A new measure for the Inpatient Quality Reporting (IQR) program that shows whether a hospital uses safe surgery practices
- Additional data on certain healthcare-associated infections (HAIs)
In addition to the penalties for hospital-acquired conditions and the data available in the Hospital and Physician Compare websites, CMS has many other programs that focus on patient safety such as value-based payments which include patient experience ratings, penalties for high readmission rates and a variety of pay-for-performance programs. CMS is quickly moving the industry toward payment programs that reward patient safety and quality of care.