Medicare Update

CMS to Hold Listening Session on 2011 Physician Quality Reporting Initiative

On December 18, 2009, the Centers for Medicare & Medicaid Services (CMS) published a Notice announcing that it will hold a Physician Quality Reporting Initiative (PQRI) listening session.  The listening session will take place from 10:00 a.m. - 4:30 p.m. (EST) on February 2, 2010.

According to CMS, the purpose of the listening session is to solicit input from stakeholders on:

• The individual quality measures and measures groups (e.g., suggestions for new measures groups or for the composition of existing measures group(s) being considered for possible inclusion in the proposed set of quality measures for use in the 2011 PQRI program); and
• Key components of the design of the PQRI program, such as possible reporting mechanisms, reporting periods, criteria for satisfactory reporting, the group practice reporting option, and public reporting of 2011 PQRI data.

See the Notice for information regarding deadlines, registration, location, submission of comments or statements, participation by telephone, and other instructions.

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CMS to Host Open Door Forum on 2010 PQRI and E-Prescribing Incentive Programs

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will host a Special Open Door Forum (ODF) on the 2010 Physician Quality Reporting Initiative (PQRI) and Electronic Prescribing (eRx) Incentive Programs.  The Special ODF will take place from 3:30 p.m. - 5:00 p.m. (ET) on January 14, 2010.

CMS reports that the Special ODF will focus on a new reporting option known as the Group Practice Reporting Option (GPRO).  During the Special ODF, CMS will provide information on GPRO eligibility, participation instructions, data submission, measures, and criteria for satisfactory reporting. Following the presentation, callers will have an opportunity to ask questions of CMS.

To participate in the Special ODF, one must dial (800) 837-1935 and reference conference ID 45243499.  CMS will also post an audio recording and transcript of the call on the Special Open Door Forums page of the CMS website, which will be accessible for download beginning on or around January 27, 2010.

For more information, see the announcement.

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CMS to Host Hospital & Hospital Quality Open Door Forum

The Centers for Medicare & Medicaid Services (CMS) will hold the next Hospital & Hospital Quality Open Door Forum at 2:00 p.m. (ET) on January 14, 2010.

To participate by telephone, one must dial 1-800-837-1935 and reference conference ID 45211596.  Beginning January 19, 2010, CMS will also make an audio recording of the Open Door Forum available.  To access the audio recording, one must dial 1-800-642-1687 and enter the conference ID.  The audio recording will be available for 3 business days.

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CMS Reports Results of 2008 Medicare Physician Quality Reporting Initiative

On November 13, 2009, the Centers for Medicare & Medicaid Services (CMS) announced that, as part of the 2008 Physician Quality Reporting Initiative (PQRI), it paid more than $92 million in incentive payments to physicians and other eligible professionals who successfully reported quality data.

According to CMS, the number of eligible professionals who earned an incentive payment in 2008 increased by one-third from 2007.  For the 2007 PQRI, CMS paid approximately $36 million in incentives. 

Among other things, CMS also reports in a Press Release and Fact Sheet that for the 2008 PQRI:

• The average incentive amount for individual professionals is over $1,000 with the largest payment to an eligible professional totaling over $98,000.
• More than 162,800 professionals participated and over 85,000 physicians and other eligible professionals met statutory requirements for satisfactory reporting.
• Nearly 8 percent of the PQRI participants attempted to send their data to CMS through a medical registry.  Of those eligible professionals, nearly 96 percent met the statutory requirements for satisfactory reporting and qualified for an incentive payment.

In addition, CMS reports that it has re-run the data used to make its initial 2007 PQRI incentive payment determinations due to several data issues. Based on the re-run data, CMS has identified over 3,900 additional eligible professionals that will receive 2007 PQRI incentive payments.  According to CMS, the payments average over $860 per eligible professional and will be made in November 2009.

Finally, CMS points out that providers can access their confidential feedback reports at the Tax Identification Number level by visiting a secure PQRI portal at http://www.qualitynet.org/pqri

Fore more information, see the Press Release and Fact Sheet.

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OIG Work Plan Reveals Possible Risk Areas for Medicare Providers and Suppliers

On October 1, 2009, the Department of Health and Human Services' Office of Inspector General (OIG) released its Work Plan for fiscal year 2010 (Work Plan).

The Work Plan addresses the areas and issues the OIG intends to audit, evaluate and inspect during fiscal year 2010.  The Work Plan also provides some insight into the areas and issues that may evolve into future OIG enforcement activities. Therefore, health care providers and suppliers should consider the Work Plan in relation to their operations.

This post briefly highlights some of the Work Plan priorities for hospitals, physicians and other health care providers with respect to Medicare Parts A and B. Work Plan priorities for Medicare provider and supplier types not addressed in this post (e.g., home health agencies) will be covered in subsequent posts.

CMS Reports on Financial Incentive/Quality Demonstration Projects

On August 17, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a Press Release announcing new results from 3 Medicare demonstrations, which are designed to evaluate whether financial incentives for improved quality can improve quality and reduce Medicare expenditures.

The 3 Medicare demonstrations are the Hospital Quality Incentive Demonstration (HQID), Physician Group Practice (PGP) Demonstration, and Medicare Care Management Performance (MCMP) Demonstration.

HQID. According to the Press Release, the HQID shows continued quality improvement among participating hospitals. Under the HQID, CMS will award incentive payments totaling $12 million in year 4 to 225 hospitals for top performance. During the first 4 years, the HQID has awarded more than $36.6 million to top performing hospitals.  The HQID began in 2003 and was designed to test payment incentives under Medicare to determine if such incentives would improve safety, quality and the efficiency of inpatient services by linking incentives to improved quality.  

PGP Demonstration. CMS reports that, in year 3 of the PGP Demonstration, all 10 participating physician groups achieved benchmark performance on at least 28 of 32 measures.  However, 2 physician groups (Geisinger Clinic and Park Nicollet Health Services) achieved benchmark performance on all 32 measures. CMS also reports that, during the first 3 years of the demonstration, physician groups have increased their quality scores an average of:

• 10 percentage points on 10 diabetes measures;
• 11 percentage points on 10 congestive heart failure measures;
• 6 percentage points on 7 coronary artery disease measures;
• 10 percentage points on 2 cancer screening measures; and
• 1 percentage point on 3 hypertension measures.

Under the PGP Demonstration, physician groups earn incentive payments based on the quality of care provided and the estimated Medicare savings generated for their patient population.  In performance year 3, CMS reports that 5 physician groups will receive performance payments totaling $25.3 million, which is their share of $32.3 million in generated Medicare savings.

MCMP Demonstration.  CMS reports that, in the first year of the demonstration, almost all of the 610 participating small and solo physician practices will be rewarded for performance on 26 quality measures.  In fact, CMS will award about $7.5 million in incentive payments to over 650 practices in California, Arkansas, Massachusetts, and Utah.  The goal of the MCMP Demonstration is to promote the use of health information technology to improve the quality of care. The demonstration even provides an additional bonus to practices that report data using an electronic health record (EHR) certified by the Certification Commission for Health Information Technology.  CMS reports that 23 percent of practices were able to submit at least some measures from a certified EHR.

In the Press Release, CMS also highlights the start of 3 additional value-based purchasing demonstrations, including the:

• Nursing Home Value-Based Purchasing Demonstration
• Medicare Hospital Gainsharing Demonstration
• Physician Hospital Collaboration Demonstration

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CMS Adds Readmissions Data to Hospital Compare Website

On July 9, 2009, the Centers for Medicare & Medicaid Services (CMS) announced that it has added data regarding hospital readmission rates to Medicare's Hospital Compare website. 

Specifically, the Hospital Compare website now provides hospital readmission rates for patients readmitted within 30 days following admission for a heart attack, heart failure and pneumonia. In doing so, the website compares a hospital's readmission rate for each of these conditions with the U.S. national rate and labels a hospital as being "Better than," "No different than," or "Worse than" the national rate.

Further, in CMS's Press Release, Department of Health and Human Services Secretary Kathleen Sebelius states that "[t]he President and Congress have both identified the reduction of readmissions as a target area for health reform." According to CMS, the U.S. national 30 day readmission rate for the 3 conditions is:

• Heart Attack - 19.9%
• Heart Failure - 24.5%
• Pneumonia - 18.2%

CMS also reports that the Hospital Compare website has been updated to provide better data on previously posted mortality rates.  For more information, see CMS's Press Release and Fact Sheet.

OIG Releases Compendium of Unimplemented Recommendations

On May 29, 2009, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) released its Compendium of Unimplemented Office of Inspector General Recommendations (May 2009).

The Compendium includes information about OIG recommendations that had not been fully implemented as of December 31, 2008.  The Compendium also includes a list of "priority recommendations," which the OIG believes represent the most significant opportunities to positively impact HHS programs.

The list of "priority recommendations" includes a number of recommendations for the Medicare program. In brief, those recommendations (and any estimated savings) include:

• Ensure accurate Medicare Part D sponsors bids and prospective payments
• Implement safeguards to prevent and detect fraud and abuse in Medicare prescription drug plans
• Ensure durable medical equipment suppliers' compliance with Medicare standards
• Modify payment policy for Medicare hospital bad debts (estimated savings $340 million)
• Reduce the rental period for Medicare home oxygen equipment (estimated savings $3.2 billion)
• Modify payments to managed care organizations (estimated savings $1.97 billion)
• Place a ceiling on administration costs included in managed care organizations' rate proposals
• Improve Centers for Medicare & Medicaid Services performance evaluation process for program safeguard contractors
• Ensure the appropriate processing of denial of Medicare payment remedies for noncompliant nursing homes
• Improve oversight of Medicare hospices

The Compendium also includes other unimplemented OIG recommendations pertaining to the Medicare program, including (but not limited to):

• Identify duplicate Medicaid and Medicare home health payments
• Require physician examination before ordering home health services
• Revise graduate medical education payment methodology
• Reduce Medicare end stage renal disease payment rates
• Improve quality oversight of ambulatory surgical centers in the Medicare program

See the Compendium for more detailed information (including background information, OIG findings, recommendations, status and any estimated savings). 

CMS Announces Pilot Program to Reduce Hospital Readmission Rates

On April 13, 2009, the Centers for Medicare & Medicaid Services (CMS) announced in a Press Release that 14 communities will participate in a Care Transitions Project (Project) to eliminate unnecessary hospital readmissions.

According to CMS, the Project serves to improve health care processes so that patients, caregivers and providers have what is needed to keep patients from returning to the hospital for ongoing care.  CMS has selected the following 14 communities to participate in the Project:

• Providence, Rhode Island
• Upper Capitol Region, New York
• Western Pennsylvania
• Southwestern New Jersey
• Metro Atlanta, Georgia East
• Miami, Florida
• Tuscaloosa, Alabama
• Evansville, Indiana
• Greater Lansing, Michigan area
• Omaha, Nebraska
• Baton Rouge, Louisiana
• North West Denver, Colorado
• Harlingen, Texas
• Whatcom County, Washington

CMS reports that each of the care transition communities is led by a Quality Improvement Organization (QIO) and that each QIO will be required to work to implement the following:

• Hospital and community system wide interventions
• Interventions that target specific diseases or conditions
• Interventions that target specific reasons for admissions

CMS will monitor the success of the Project by watching the rates of readmission. 

According to CMS, the Project will continue in all 14 communities through summer 2011. More information on the Project can be found here.

OIG Releases Government/Industry Roundtable Report on Quality of Care

On March 23, 2009, the Department of Health and Human Services' Office of Inspector General (OIG) released a government-industry roundtable report entitled Driving for Quality in Acute Care: A Board of Directors Dashboard (Report).

In November 2008, the OIG and Health Care Compliance Association co-sponsored the government-industry roundtable.  Participants included representatives from 27 hospital systems, hospital trade associations and government agencies.  The roundtable was designed to foster dialogue among the various stakeholders committed to improving compliance and promoting the care of Federal health care program beneficiaries, including Medicare beneficiaries.

The OIG reports that the roundtable focused on how hospital boards of directors can use information dashboards or scorecards as a tool to promote quality of care. The OIG also reports that the group discussed their experiences in measuring and reporting quality indicators, ways to increase boards of directors' engagement in quality of care issues, and information on best practices for tracking measures of quality, safety, consumer satisfaction, and financial and employee performance. In addition, participants offered suggestions for increasing accountability for quality outcomes and stressed the importance of promoting transparency of quality of care information.

The Report can be found here.