Leapfrog Group, AHA give mixed reviews to CMS’ final inpatient payment rule

Healthcare
The AHA said the rule offers plenty to like in terms of easing administrative burden, but there are elements that they would need to evaluate further. (Getty/sudok1)

Industry groups are weighing in on CMS’ final Inpatient Prospective Payment System (IPPS) rule, and they see both pros and cons in the regulation. 

Leah Binder, President of the Leapfrog Group, said the organization is “disappointed” that the Centers for Medicare & Medicaid Services will cut a set of “critical patient safety and infection measures” from the Inpatient Quality Reporting Program (IQR), which was created under the second Bush administration to give patients access to hospital quality data. 

“There should be no compromise in public access to critical, life-and-death information about hospitals,” Binder said. 

Conference

2019 Drug Pricing and Reimbursement Stakeholder Summit

Given federal and state pricing requirements arising, press releases from industry leading pharma companies, and the new Drug Transparency Act, it is important to stay ahead of news headlines and anticipated requirements in order to hit company profit targets, maintain value to patients and promote strong, multi-beneficial relationships with manufacturers, providers, payers, and all other stakeholders within the pricing landscape. This conference will provide a platform to encourage a dialogue among such stakeholders in the pricing and reimbursement space so that they can receive a current state of the union regarding regulatory changes while providing actionable insights in anticipation of the future.

Measures that will be cut from the program include: 

  • Catheter-associated urinary tract infection rates
  • Clostridium difficile infection rates
  • Surgical site infections related to hysterectomy or colon procedures
  • Methicillin-resistant Staphylococcus aureus infection rates 

The measures will be removed from IQR beginning in 2020, though the measures will still be used on Hospital Compare, the Hospital Acquired Condition Reduction Program and the Value Based Purchasing Program. CMS had originally proposed eliminating the measures from the latter in addition to the IQR but changed course for the final rule. 

RELATED: Number of hospitals achieving zero infections drops, Leapfrog Group finds 

Leapfrog did commend CMS for its decision to reverse changes to the Value-Based Purchasing Program and that the safety data will still be available elsewhere in some form. However, cutting them from IQR rejects a strong response from advocacy groups, payers and other stakeholders, Binder said. 

CMS also said in the rule that it will delay removing the data by a year compared to the proposed rule to ensure that it has time to build infrastructure to house the eliminated data. Binder said Leapfrog will work with the agency to see that through. 

CMS crafted the rule to align with its ongoing “Patients over Paperwork” initiative, which is aimed at reducing administrative burdens on providers. The American Hospital Association commended CMS for that effort and said it was “encouraged” by the steps taken toward streamlining quality measurements. 

“There are a number of policies CMS finalized today that will reduce regulatory burden and help ensure America’s hospitals and health system can continue to provide high-quality, efficient care for the patients and communities they serve,” Tom Nickels, AHA’s executive vice president for government relations and public policy, said in a statement. 

RELATED: This is the biggest barrier to consumer price shopping 

AHA also praised several other changes in the rule, such as eliminating the 25% rule for long-term hospitals and adding some additional flexibility for Meaningful Use requirements. However, it said that it would need to evaluate some additional changes—such as those affecting area wage index—further. 

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