Quality Measures Resource Center: Update on eCQM Reporting & ICD-10 Assistance

Editor’s Note: This news column runs in conjunction with our online Quality Measures Resource Center. For more quality measures-related materials, visit www.todayswoundclinic.com/articles/quality-measures-resource-center.

MS Announces Updates To Electronic Quality Reporting

Centers for Medicare & Medicaid Services (CMS) has released updates on select electronic clinical quality measures (eCQMs) that eligible professionals and eligible hospitals will report in 2016 in accordance with the CMS Electronic Health Record Incentive Program. These updates pertain to corrections needed to the original version of the measures that were posted to the CMS website in May for the annual update of the 2014 measure set. Errors were reportedly found in the Extensible Markup Language (aka XML) renderings of 12 eligible professional eCQMs and four eligible hospital eCQMs. Corrections for these measures should affect only those who are electronically consuming the Healthcare Quality Measures Format. The measures affected by this update are listed on the CMS website. Visit www.cms.gov for more information.

CMS, AMA Announce Efforts To Help Providers With ICD-10

With little more than one month remaining until the deadline for conversion to ICD-10-CM arrives (Oct. 1), the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are combining efforts to assist healthcare providers as they prepare for medical diagnoses coding overhaul. In response to requests from the provider community, CMS has been releasing additional ongoing guidance that will allow for flexibility in the claims auditing and quality-reporting process as the medical community gains experience using the new code set.  Additionally, CMS and AMA officials have, as a means of acknowledging the help that healthcare providers have needed to make the transition, announced plans for a collaborative effort to ensure providers are ready for the switch ahead of schedule.  These efforts include educating providers through webinars and online videos, onsite training, educational articles, and national provider calls. CMS has also released an ICD-10 communications and coordination center and will be offering Medicare acknowledgement testing for providers through Sept. 30th. For more information, visit www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10.

Quality Measure Bonuses Expected

Eligible healthcare providers who’ve successfully implemented quality measures into their patient care will be receiving notice of related financial rewards in the coming months.  According to a report by MedPage Today, the Centers for Medicare & Medicaid Services (CMS) is expected to begin distribution of money tied to financial incentives based on various quality measures in October (as well as levy the most recent round of fines for “excessive” hospital readmissions). While CMS had not yet announced the specific awards, the financial incentives are estimated to total about $1.5 billion, according to the MedPage report. At this time, financial punishments are also expected to be given based on high rates of infection and other “avoidable occurrences of patient harm.”

Hospitals Facing Readmission Penalties

Created as part of the Affordable Care Act (ACA) of 2010, the Hospital Readmissions Reduction Program was designed to encourage hospitals in the United States to be more cognizant of their Medicare patients’ health status following discharge as a means of helping people remain healthy and out of the hospital — and tying financial penalties to those facilities that experience “excess readmissions” among all patients discharged on and after Oct. 1, 2012. Just past the midway point of 2015, it’s evident that providers are still struggling with this aspect of healthcare quality.  According to a recent report published by MedPage Today, the majority of our nation’s hospitals are still incurring reduced payments by Medicare for having patients who frequently return within one month of discharge. The most recent government records reportedly show a combined $420 million lost. That’s not the worst of it, financially speaking. Now in the fourth year of being subjected to federal readmission penalties, more than 2,500 hospitals are expected to receive lower payments for any Medicare patients who stay in their facilities, whether or not it’s due to a readmission — as of October.

While national readmission rates have reportedly dropped since the ACA, roughly one in five Medicare patients returns to the hospital within one month of discharge, according to the report. Fines will reportedly be applied to Medicare payments when the federal fiscal year begins in October, with the average payment reduction said to be 0.61% per patient stay. Nearly 40 hospitals are expected to receive the maximum cut of 3%. More than 500 hospitals stand to lose at least 1% of their Medicare payments. However, the fines are slightly less than they were last year, according to the MedPage report.

This resource guide is made possible through the support of Hollister Inc., Libertyville, IL. The statements made within are not connected to any officials or providers affiliated with the company.