Eloquest Healthcare is excited to welcome back Jo Ann Brooks PhD, RN, FAAN, FCCP to the Eloquest Healthcare Blog! Jo Ann is the former System Vice President for Safety and Quality at Indiana University Health (a 16 hospital system) based in Indianapolis, IN. She lectures frequently on quality and CMS pay for performance measures and presently serves on the National Quality Forum Admissions/Readmissions Steering Committee.

Her clinical background is pulmonary and her research interest is hospital acquired pneumonia. She is a past Board Member of AACN and is active in the American College of Chest Physicians on numerous committees.

She is an adjunct faculty member for Indiana University and Purdue University schools of nursing. Dr. Brooks has published extensively with both book chapters and articles and continues to work actively in a consulting role.

Over the past 10 years, acute care hospitals have been barraged and burdened with the requirement to report an increasing number of quality measures. It began with the Centers for Medicare and Medicaid Services (CMS) Inpatient Quality Reporting Program (IQRP) in 2006. Each year hospitals are required to report on quality measures on a quarterly basis and the number of measures increased each year.

With the implementation of the Affordable Care Act, since 2012 hospitals have also been involved with the pay-for-performance programs of Hospital Value-Based Purchasing (VBP), Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition Reduction Program (HACRP) (Patient Protection and Affordable Care Act. March, 2010. PPACA-Section 3004-3006, Public Law 111-148, March 23, 2010).

There are two important topics to review regarding hospital pay-for-reporting and pay-for- performance: the CMS Meaningful Measures initiative and the recent Medicare Payment Advisory Commission’s (MEDPAC) recommendations to redesign the CMS hospital quality programs.

To decrease the burden of quality measures and focus on high priorities for improving patient outcomes, CMS Administrator Seema Verma announced a new initiative for quality measurement, called “Meaningful Measures” on October 30, 2017. The purpose of the initiative is to serve as a connector to the CMS strategic goals and the overall goal is to achieve high quality healthcare with meaningful outcomes for patients.

The framework for this initiative has eight objectives: address high impact measure areas that safeguard public health, identify patient-centered measures and those that are meaningful to patients, use outcome based measures where possible, use measures that are relevant for and meaningful to providers, minimize level of burden for providers, use measures which have a significant opportunity for improvement, address measure needs for population based payment through alternative payment models and align measures across programs and/or with other payers (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html).

This initiative is clearly a move in the right direction to develop a strategic framework for identifying appropriate quality measures for CMS programs. Changes relating to the Meaningful Measures initiative occurred in the recent 2019 Inpatient Prospective Payment Rule. For example, 39 measures were removed from the IQPR program and some changes were made in the CMS pay-for-performance programs (FY2019 IPPS Final Rule. Federal Register https://federalregister.gov/d/2018-16766). For more information go to the CMS Meaningful Measures website.

More recently, there was a BIG CHANGE recommended for the CMS hospital quality programs. Each year the MEDPAC reviews Medicare payment policies and makes recommendations to Congress. Having reviewed the CMS hospital quality programs during previous meetings, on January 17, 2019 MEDPAC voted unanimously to recommend the consolidation of hospital quality initiatives into a single program linking Medicare payments to the quality of care (MEDPAC. Report to Congress, Medicare and the Health Care Delivery System, June 2018; MEDPAC meeting, January 17-18, 2019.)

The reasons for this recommendation were to maintain a level of financial pressure on hospitals to limit cost growth, minimize differential in payment rates across sites of care, move Medicare payments toward the cost of efficiently providing high quality care and reward high performing hospitals (MEDPAC Slide deck, Assessing payment adequacy and updating payments for hospital inpatient and outpatient services and redesigning Medicare’s hospital quality incentive programs. Stephanie Cameron, Ledia Tabor, & Jeff Stensland. January 17, 2019,http://medpac.gov/-documents-/reports).

All the details of the Hospital Value Incentive Program (HVIP) are not yet available, but the new program will merge the existing HRRP, HVBP and HACRP programs and eliminate the IQRP. The new HVIP will have five measure domains: readmissions, mortality, spending (Medicare Spend per Beneficiary), patient experience and hospital-acquired conditions. Each measure domain will have a continuous performance-to-points scale from 0-10 points. The total HVIP score is the average of all points across the five measure domains.

There will be clear, absolute and prospective performance targets; peer groups will be used to account for social risk factors and a pool of dollars will be distributed to hospitals based on performance (MEDPAC Slide deck, Assessing payment adequacy and updating payments for hospital inpatient and outpatient services and redesigning Medicare’s hospital quality incentive programs. Stephanie Cameron, Ledia Tabor, & Jeff Stensland. January 17, 2019. http://medpac.gov/-documents-/reports). MEDPAC recommends that this program should start in 2020. Never a dull moment-stay tuned for more information to be released on the MEDPAC recommendations and the HVIP!