AHA asks CMS to reconsider 2009 quality measures, payment rates

The American Hospital Association isn't too happy about the quality-reporting requirements in the new proposed outpatient prospective system rule for 2009, and it would like to see CMS make some changes. For one thing, it doesn't like the medical-imaging efficiency measures, which haven't gone through the National Quality Forum endorsement process, or been adopted by the Hospital Quality Alliance. The AHA argues that the measures should be vetted by both groups.

Meanwhile, the AHA says CMS hasn't demonstrated that creating two cost centers for drugs--which will impose new accounting and billing burdens on hospitals--will actually improve payment accuracy. Also, the group argues that the proposed payment rate for separately covered outpatient drugs is based on a method that contains flaws. The proposed payment rate, at an average sales price plus 4 percent, doesn't represent the acquisition cost of outpatient drugs. AHA is recommending a rate of the average sales price plus 6 percent, as paid to physician offices.

On the other hand, the AHA supports the CMS process for validating outpatient quality data, which AHA says will improve the accuracy of quality data, and already improves on the inpatient program, as well as its proposal to pay for partial hospitalization programs using two new ambulatory payment classes. AHA would like to see hospital-based partial hospitalization rates paid for both ambulatory payment classes.

To learn more about the letter:
- read this Modern Healthcare article
- read the AHA letter (.pdf)

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