# Presentation: 218271

## 2009 IPPS Proposed Rule Updates

**AHIC Presentation **
**May 9, 2008**
**Debbra Hattery RN, MSN**
**Deputy Director of Quality Measurement and Health Assessment Group**
**Office of Clinical Standards and Quality**
**Centers for Medicare & Medicaid Services**

## 2009 IPPS Proposed Rule Changes

- Proposing 43 new measures
- Retirement of 1 measure
- 6 new measure topics
- Hospital Acquired Conditions Present on Admission

## New Measure Topic Areas	

- Stroke (5) Chart Abstracted
- VTE (6) Chart Abstracted
- Readmission (3) Claims Based
- Nursing Sensitive (4) Chart Abstracted
- AHRQ Quality Indicators (9) Claims
- Cardiac Surgery (15) Registry

## Retirement

- CMS is proposing the retirement of Oxygenation Assessment for Pneumonia Patients.  The measure has achieved a high level of success in the vast majority of IPPS hospitals.

## Present on Admission

- Beginning on October 1, 2008, patients who acquire certain Hospital Acquired Conditions will received higher MS-DRG payments if that condition was Present on Admission (POA).  This indicator will be on the claims form

## Hospital Acquired Conditions

- Object inadvertently left in during surgery
- Air embolism
- Blood incompatibility
- Catheter associated urinary tract infection
- Pressure ulcer (decubitus ulcer)
- Vascular catheter associated infection
- Surgical site infection- Mediastinitis (sternal wound infection) after coronary artery bypass graft surgery
- Certain types of falls

## HCN Study

- The Healthcare Collaborative Network began work in 2002 to determine data elements that could be collected electronically
- In 2005, CMS contracted with CFMC and IBM to build a “Gateway” for the information using the standards at the time.
- Three hospitals and 1 hospital system were chosen for the study
- Selected measures from the core set were used based on their data elements
- The study met many roadblocks including transmission errors, security issues, and standardized terminology problems.

## Study

- The selected terminology used was SMOMED and the transmission media was HL-7
- Hospitals transmitted de-identified patient records via the Gateway.  The data was then aggregated and sent to CFMC
- CFMC compared the electronic data to the data in the clinical warehouse

## HCN

- CFMC found that the HCN data yielded lower measure rates than traditional data collection methods.  There were critical gaps in the information regarding ED, medications, and transfer data.

## CARE

- Develop an electronic, standardized,
- patient assessment instrument to support:
- Clinical Excellence
- Quality Measurement
- Equitable Payment

## Instrument Development

- CARE will be used at
- Hospital discharge
- Across Post Acute Care settings (SNFs, IRFs, HHAs, LTCHs)
- Admission
- Interim point & Significant Changes
- Discharge
- Offer downstream information to providers

## Challenges CMS will Encounter

- Privacy Issues
- Strong emphasis on ensuring that protected patient information can only be seen on a “Need to Know” basis
- Adopting accepted Healthcare Information Technology Standards now and in the future
- Provide a “Level Playing Field” for all Healthcare IT vendors

## Considerations

- CMS continues to strive towards electronic data collection.  Our current measures are not specified for collection from an EHR. Other issues include security risks and infrastructure.

## Future Considerations

- 	We have proposed the use of a data registry which will decrease burden on hospitals
- CMS would also like to explore receiving lab data electronically for use in Risk Adjustment Models.
- Seeking comment on the use of the CARE tool to advance the use of health IT in automating the process for collecting and submitting data.

## Rule Timeline

- April 14-Proposed rule available on the CMS website
- April 30-Proposed rule published in FR
- June 13-Public comment period ends
- Beginning of August-Final Rule issued

## Public Comment	

- The public comment period ends June 13, 2008.  Please use this opportunity to comment on the proposed rule.  All comments are addressed in the Final Rule

## Public Comments can be submitted in 4 ways

- 1. _Electronically_. to _http://www.regulations.gov_. Follow the instructions for "Comment or Submission" and enter the file code CMS-1390-P to submit comments on this proposed rule.
- 2. _By regular mail_. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1390-P, P.O. Box 8011, Baltimore, MD 21244-1850. Please allow sufficient time for mailed comments to be received before the close of the comment period. CMS-1390-P 4
- 3. _By express or overnight mail_. You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1390-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
- 4. _By hand or courier_. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to either of the following addresses: a. Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201