August 24, 2022

Reduction is not always a negative concept. One need only visit the local health spa and espy those working to reduce their weight and waistlines to draw that reasonable conclusion. Reducing dependence on harmful substances and hurtful habits is considered a positive thing, as well. Reducing one’s debt is not a bad idea, either. In fact, it’s something most financial advisors encourage us to do. So, it should come as no surprise to find that the government created guidelines designed to encourage hospitals to reduce negative outcomes.

In our continuing review of the recently released 2023 Inpatient Prospective Payment System (IPPS) Final Rule (FR), today’s alert will focus on two Centers for Medicare and Medicaid Services (CMS) reduction programs. Specifically, these programs are designed to reduce the rate of readmissions, as well as hospital-acquired ailments. Our primary source material for the below highlights is an extended fact sheet released by CMS that outlines the primary provisions of the 2023 IPPS FR.

Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that reduces payments to hospitals that are found to have an inordinate number of readmissions. This program supports the government’s goal of improving healthcare for Medicare beneficiaries by linking payment to the quality of hospital care. Based on the 2023 IPPS FR, CMS is:

• Resuming the Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate following Pneumonia Hospitalization measure, beginning with the FY 2024 program year following the pause of this measure which was previously finalized for FY 2023;
• Modifying the Hospital 30-Day, All-Cause, Risk-Standardized Readmission Rate following Pneumonia Hospitalization measure to exclude patients with COVID-19 diagnosis present on admission from the measure numerators (outcomes) and denominators (cohorts), beginning with the FY 2024 program year (confidential hospital feedback reports for this measure will include this modification for the FY 2023 program year. Although the measure has been paused from being used for payment calculation for the FY 2023 program year, CMS will still be calculating and publicly reporting this measure);
• Modifying all six condition/procedure specific readmissions measures to include a risk adjustment for history of COVID-19 within 12 months prior to the index admission, beginning with the FY 2024 program year.

Additionally, CMS sought and received public comment on promoting health equity through possible future incorporation of hospital performance for socially at-risk populations into the Hospital Readmissions Reduction Program, which will be used to inform future policy development.

Hospital-Acquired Condition Reduction Program

The Hospital-Acquired Condition (HAC) Reduction Program creates an incentive for hospitals to reduce the incidence of hospital-acquired conditions by reducing payment by one percent for applicable hospitals that rank in the worst performing quartile on select measures of hospital-acquired conditions. According to the FR, CMS is:

• Pausing the Patient Safety and Adverse Events measure (CMS PSI 90 measure) and the five CDC NHSN Healthcare-Associated Infection (HAI) measures from the calculation of measure scores and the Total HAC Score, thereby not penalizing any hospital under the HAC Reduction Program FY 2023 program year;
• Publicly and confidentially (through Hospital Specific Report) reporting CDC NHSN HAI measure results;
• Calculating and publicly reporting the CMS PSI 90 measure displayed on the main pages of the Care Compare tool hosted by HHS after confidentially reporting these results to hospitals with a 30-day preview period;
• Pausing CY 2021 CDC NHSN HAI measures data from the FY 2024 HAC Reduction Program Year;
• Making a technical update to the measure specification to adjust the minimum volume threshold for the CMS PSI 90 measure beginning with the FY 2023 program year;
• Making a technical update to the CMS PSI 90 measure specifications to risk-adjust for history of COVID-19 diagnosis beginning with the FY 2024 program year;
• Updating the NHSN CDC HAI data submission requirements for newly opened hospitals beginning with the FY 2024 HAC program year; and
• Clarifying the removal of the no mapped location policy beginning with the FY 2023 program year.

Additionally, CMS requested and received information from stakeholders on the potential future adoption of two digital National Healthcare Safety Network (NHSN) measures: the NHSN Healthcare-associated Clostridioides difficile Infection Outcome measure and NHSN Hospital-Onset Bacteremia & Fungemia Outcome measure.

We will have at least one more update for our readers concerning the 2023 IPPS Final Rule in upcoming weeks. In the meantime, if you would like to contact us, please go to info@miramedgs.com.