ACC to CMS: Rework inpatient payment system

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The American College of Cardiology (ACC) has put in its two cents to the Centers for Medicare & Medicaid Services (CMS) about the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals for 2013, urging CMS to rework some of its proposed rules, such as dismembering the implementation of a hospitalwide 30-day readmission measure.

First, CMS has proposed that surgical site infection following cardiac implantable electronic device (CIED) procedure be classified as a preventable hospital-acquired condition (HAC). This would mean that an infection would not allow an increased payment under the Medicare-Severity Diagnosis-Related Group (MS-DRG) system.

ACC has expressed concerns with the notion, saying that while it commends CMS for attempting to reduce infection rates, it said that infections in patients receiving CIEDs do not meet the requirements to establish this as a preventable HAC.

While ACC urged CMS to forfeit the finalization of the rule, it said that if the agency chose to go through with it, then ACC would recommend a modification to the ICD-9 diagnosis code.

Additionally, ACC had concerns with CMS’ notion to reclassify percutaneous mitral valve repairs into a new set of MS-DRGs. Currently, mitral valve procedures are paid under MS-DRGs that are used to report PCI. CMS is proposing to maintain the current DRG assignments for mitral valve repair.

ACC offered that mitral valve procedures are more similar to surgical valve repairs and proposed that CMS reassign percutaneous mitral valve repair to the MS-DRG used for surgical valve repair and transcatheter aortic valve replacement (TAVR) because the resources are more aligned than those used with PCI.

ACC also opposed CMS’ notion to implement a hospitalwide 30-day readmission measure as part of the Inpatient Quality Reporting program. While ACC said it is committed to reducing readmissions, the risk models for this measure may not properly assess for all factors.

ACC said that it also supports CMS’ proposals to:

  • Include smoking cessation measures developed by the Joint Commission;
  • Add AMI-10 performance measurements of statins prescribed at discharge;
  • Realign quality measures around the domains of the National Quality Strategy; and
  • Include patient-reported measures as part of a performance measurement and improvement program.

The information was included in a letter dated June 21 sent from ACC President William A. Zoghbi, MD, to CMS’ Acting Administrator Marilyn Tavenner. The Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals was published in the Federal Register May 11.