Medicare Compliance & Reimbursement

Agency says incentive payments will be harder to qualify for.

How well a hospital provides prevention measures for surgical infections and pneumonia could determine whether they will receive incentive payments.

On Sept. 2, the Centers for Medicare and Medicaid Services and the Hospital Quality Alliance released new quality information on the Hospital Compare Web site about increases in hospital reporting and new quality measures.

"As we enhance the information on hospital quality, patients can get more help in making important decisions about their care, and health professionals can take further steps to improve care," CMS Administrator Mark McClellan said in a statement.

CMS added two new surgical infection prevention measures and a new pneumonia measure. These additions bring the total number of measures to 20, "including the 10 clinical measures that short-term acute care hospitals must agree to report publicly in order to receive the incentive payments," the agency noted.

The Surgical Care Improvement Project spurred the new surgical infection prevention measures, which CMS will collect as a part of a larger set of patient safety measures related to the project. SCIP's goal is to reach a 25-percent reduction in postoperative complications by 2010, CMS said.

According to the agency's new hospital quality data, more than 90 percent of participating hospitals are reporting on at least the "starter set" of 10 measures and
more than 70 percent are reporting all 17 of the quality measures. More than 80 percent of participating hospitals reported on the new pneumonia measure and approximately 20 percent reported on patient safety using the two new surgical infection prevention measures, the agency noted.

More than 450 critical access hospitals--which are not eligible to receive the incentive payments--are also submitting data to CMS.

"Certain processes appear to be well ingrained in U.S. hospitals--rates for aspirin at arrival and discharge and beta blocker at discharge for heart attack patients and assessment of blood oxygen levels for pneumonia patients remain high--but the rates for other measures indicate a continuing need for improvement efforts at the national level," McClellan noted.

Hospitals are reporting higher rates of counseling smokers to quit, especially among pneumonia and heart failure patients. Despite the positive new data, McClellan expressed a need for improvement in a number of important areas to avoid costly complications and provide quality of care.

"While it is too early to determine any major trends in hospital performance on the measures, the latest information makes it even clearer that there are important opportunities for quality improvement," McClellan maintained.