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CMS pays out for hospital outpatient services reporting in 2009

Written by Editorial Staff   
January 9, 2009
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CMS updates quality reporting for outpatient imaging. Image Source: Community Mercy HealthPartners  
The Centers for Medicare & Medicaid Services (CMS) has notified more than 3,000 U.S. hospitals that they will receive the full payment update for calendar year 2009 as part of the new Hospital Outpatient Quality Data Reporting Program.

These hospitals represent 99.3 percent of all hospitals that participated in 2008 in the program, designed to strengthen the tie between the quality of care furnished to people with Medicare in hospital outpatient departments and the payments hospitals receive for those services, according to the agency.

“The reporting program represents another major step toward value-based purchasing of healthcare services to ensure that patients with Medicare and the American taxpayers get the best outcomes for their healthcare dollars,” said Kerry Weems, CMS administrator.

In all, of the 3,339 hospitals that participated in the program, 3,313 will receive the full 2009 update under the quality data reporting program. Of the remaining 26, that will receive the reduced update, 18 did not report the quality data successfully, while eight did not have a QualityNet Administrator.

The reporting program was mandated by the Tax Relief and HealthCare Act (TRHCA) of 2006, and applies to all hospitals paid under the hospital outpatient prospective payment system (OPPS). The program does not apply to:
  • Hospitals excluded from the OPPS:
  • Maryland hospitals subject to special payment rules reflecting state hospital payment laws;
  • Hospitals outside of the 50 states, the District of Columbia and Puerto Rico;
  • Indian Health Service Hospitals; and
  • Certain other OPPS-exempt hospitals.

Under TRHCA, CMS said that eligible hospitals that report outpatient quality data receive the full market basket update; those that do not receive an update that is reduced by two percentage points. Quality data will give CMS a baseline of data from which an eventual pay-for-performance outpatient system could be created.

In 2008, hospitals participating in the program were required to report data on the seven quality measures that measure important elements of high-quality myocardial infarction (MI) and surgical care, which is of particular importance to Medicare beneficiaries. These measures included:
  • The percentage of MI patients given aspirin when they arrive at the ER;
  • The amount of time it takes for a MI patient to receive clot-busting drugs;
  • The percentage of MI patients who received clot-busting drugs within 30 minutes of arriving in the ER;
  • The average time it takes a MI patient to receive an ECG test to assess heart damage once they arrive in the emergency room; and
  • The average time it takes for a heart attack patient to transfer to another hospital to receive a coronary angioplasty as acute treatment for an MI.
The OPPS calendar year 2009 final rule added four imaging efficiency measures to the seven original measures for reporting to receive the full update in the calendar year 2010.