Final CMS IPPS rule for fiscal year 2009 expands list of quality reporting requirements and nonpayment for ‘never events’

CMS yesterday released its inpatient prospective payment system (IPPS) final rule for fiscal year (FY) 2009, expanding the list of preventable conditions for which it will withhold payments and the number of quality measures that hospitals will be required to report to receive the full market basket update in FY 2010. Meanwhile, although CMS had previously proposed adding 43 measures to the list of quality metrics that hospitals must report to receive the full market basket update, the final rule scales back that expansion, adding 13 new measures to the current list of 30 and deleting one pneumonia measure. CMS also added three new hospital-acquired conditions (HAC) to its non-payment list and expanded the number of quality measures hospitals must report on to 42. CMS also decided to retire one pneumonia measure – oxygenation assessment – effective January 1, 2009, bringing the total number of measures to 42.

The new HACs include:

• Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity

• Certain manifestations of poor control of blood sugar levels

• Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

Hospitals will not be reimbursed for those conditions beginning October 1, 2008, if they could have been reasonably prevented. The three are in addition to the eight HACs approved in 2007. Medicare will stop paying for those eight on October 1, 2008 as well.

Of the 13 new measures only four of those have been adopted by the Hospital Quality Alliance (HQA). AHA Vice President for Policy Don May said the association was disappointed with CMS’ decision to add nine measures that have not been adopted by the HQA.CMS says it will review feedback received during the 30-day public comment period; issue a proposed national coverage decision memorandum by Feb. 1, 2009; and finalized its policy by April 30, 2009. The final rule will be published in the Aug. 18 Federal Register. ( SOURCES: CMS final rule , CMS release, 7/31; Reichard, CQ HealthBeat, 7/31 [subscription required]; Advisory Board Daily Briefing , www.advisory.com , August 1, 2008; AHA News Now , www.ahanews.com , July 31, 2008; HCPro Quality Improvement Monitor , www.hcpro.com, August 8, 2008)