Pay for performance is an emerging movement — in which providers are rewarded for the quality of their health care services — among health plans and insurers (the Centers for Medicare & Medicaid Services and others). Some programs are initially providing financial incentives to participate in quality reporting. However, the overall movement focuses on financially rewarding high quality patient care or financially penalizing poor quality of care. The CHA Board has adopted a partial payment or non-payment policy related to billing for preventable adverse events that are under the control of the hospital.
The Measure Application Partnership (MAP) has released its draft pre-rulemaking recommendations on performance measures under consideration for federal quality reporting and payment programs. MAP reviewed 234 measures submitted by the U.S. Department of Health and Human Services (HHS) for 20 federal programs that reimburse providers, including clinicians, hospitals and post-acute care facilities. The attached draft report includes tables that summarize MAP’s recommendations for each federal program. CHA participated in the MAP process and will prepare formal written comments reflecting member discussions held in December and submit the comments by Jan. 27. The comment period is open to the public, but comments can only be submitted by registered users of the National Quality Forum’s (NQF) website. As required by the Affordable Care Act, MAP must release its final report to HHS by Feb. 1.
Hospital-based dialysis facilities paid under the end-stage renal disease (ESRD) prospective payment system (PPS) will see an estimated 0.8 percent increase in payments for calendar year (CY) 2014 compared to CY 2013, according to a final rule issued by the Centers for Medicare & Medicaid Services (CMS). CMS estimates that independent ESRD facilities will see no increase in payments in CY 2014 as compared to CY 2013. The update reflects the effect of a 3.2 percent ESRD bundled market basket update; the Affordable Care Act-required productivity adjustment of 0.4 percent; the American Taxpayer Relief Act (ATRA)-required drug utilization adjustment of negative 3.3 percent; a 0.4 percent overall estimated increase in outlier payment from the updates to the fixed-dollar loss threshold and Medicare Allowable Payment amounts; and a 0.2 percent overall estimated increase in payments from the change in the blend of payments.
Recordings of recent conference calls held by the Centers for Medicare & Medicaid Services on the quality reporting programs for inpatient rehabilitation facilities (IRFs) and long-term-care hospitals (LTCHs) will be available July 30 through Aug. 1. Facilities may access the calls by dialing (855) 859-2056, and using conference IDs 13189170 for IRFs and 13198135 for LTCHs. As mandated by the Affordable Care Act, IRF and LTCH quality reporting programs will begin Oct. 1.