2017 IPPS proposed rule and claims-based quality and cost measures--hold on to your seats!

The FY 2017 IPPS proposed rule released April 27 is replete with modifications and expansions to claims-based quality and cost outcome measures. Although many of these proposed changes are for future fiscal years, ICD-10 codes reported for current discharges will impact the future financial performance for our organizations.

Cost measures

Two new payment measures are proposed as additions to the efficiency and cost reduction domain beginning in FY 2021:

• Hospital Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care for Acute Myocardial Infarction
• Hospital Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care for Heart Failure

CMS cites the following site for full measure specifications: www.cms.gov/Medicare/Quality-Initiatives-Patient-assessment-Instruments/HospitalQualityInits/Measure-Methodology.html.

The risk adjustment methodologies used for these measures are similar to those used for risk-adjusted mortality. The payment measure is intended to be paired with the 30-day mortality measures, thereby directly linking payment to quality by the alignment of comparable populations and risk adjustment methodologies to facilitate the assessment of efficiency and value of care.

The baseline period for these measures is July 1, 2012, through June 30, 2015. The performance period for these measures is July 1, 2017, through June 30, 2019. Performance for these new measures will be scored using the methodology used for the Medicare Spending Per Beneficiary measure.

CMS expands on its interest to further integrate quality and cost measures to reflect value, and is seeking public input on potential approaches. Underlying present challenges in reflecting value are noted as follows:

• Currently, the HVBP assesses quality and efficiency separately through distinct performance measures in different domains, which as of FY 2018 are equally weighted to create the overall Total Performance Score. The four domains include:
  • Safety
  • Efficiency and cost reduction
  • Clinical care
  • Personal and community engagement
• The current scoring approach can permit a hospital to earn a higher payment adjustment relative to other hospitals by performing well on quality-related domains without performing well in the efficiency and cost reduction domain, or vice versa.
• Without a measure or score for value that reflects both quality and costs, the ability to assess value is limited.

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