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Outpatient Quality Steamroller Coming

November 25, 2008
by Mark Hagland
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Late last month, the federal Centers for Medicare and Medicaid Services (CMS) announced that it would more tightly link payment to quality of care for hospital outpatient departments. In publishing a final rule establishing Medicare payment and policy changes for services in hospital outpatient departments and ambulatory surgery centers for 2009, CMS announced that it would no longer pay hospitals for care related to illness or injuries acquired by the patient during a hospital outpatient encounter. This policy change, which could be implemented in the relatively near future, would extend the Medicare program’s recent change in policy on payments for inpatient hospital-acquired conditions.

Among other specific elements of the final rule, “CMS will reduce the calendar-year 2009 payment update factor by 2 percentage points for most services for hospitals that were required to report quality measures but failed to meet requirements of the HOP QDRP [Hospital Outpatient Quality Data Reporting Program] for CY 2009,” CMS announced on its website. And the number of quality of care measures that hospitals will be required to report in order to receive the full CY 2010 market basket update will be raised from 7 measures in CY 2008 to 11 measures in CY 2009, with the addition of four imaging efficiency measures to be calculated using Medicare claims data.

In short, the feds are wising up to outpatient department-acquired infections and illnesses as well as to inpatient-acquired ones. And they’re adding ever more quality measures that must be collected and reported.

The implication for us is clear. Developing optimal systems for tracking, collecting, and reporting all the kinds of clinical data that CMS, and increasingly private payers, will be demanding, will only become more urgent and timely. Are your organization's information systems up to current requirements? How about near-future requirements?

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