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IPPS Proposed Rule Adds Readmission Measures, HAC Timeline

Cheryl Clark, for HealthLeaders Media, April 29, 2013

The agency is adding COPD because it was the fourth leading reason for readmissions according to a 2007 Medicare Payment Advisory Commission report, and because there is wide variation in the rates (from 18% to 25%) of COPD hospital readmissions "supporting the finding that opportunities exist for improving care" that can result in fewer COPD readmissions.

The agency wants to add hip and knee surgeries to the readmission algorithm because together they "account for the largest procedural cost in the Medicare budget," 1.4 million surgeries between 2008 and 2010, and because evidence shows "variation in readmissions of patients with THA/TKA." While the readmission rate for these orthopedic procedures was lower, an average of 5.7%, it ranges from 3.2% to 9.9%.

A section of the Patient Protection and Affordable Care Act calls for CMS to add four conditions or procedures to the algorithm for readmissions penalty by FY 2014, "to the extent practicable." The four include COPD, coronary artery bypass graft surgery, percutaneous coronary intervention (PCI) and other vascular conditions.

The agency is foregoing addition of PCI and vascular conditions because inpatient admissions for both "seem to be decreasing" as they are increasingly performed in hospital outpatient departments. It is exploring adding CABG in the future.

The agency proposes to greatly broaden the number of procedures that would be exempted from being considered a readmission. These include obstetrical delivery, transplant surgery, maintenance chemotherapy, and rehabilitation.

"Otherwise, a planned readmission is defined as a nonacute readmission for a scheduled procedure." It added that "admissions for acute illness or for complications of care are never planned."

Value-Based Purchasing Incentive Program
The measures for which hospitals may receive an incentive payment, (1.25% of a hospital's Medicare base DRG, which is withheld from all eligible hospitals for a $1.1 billion estimated pool) as of Oct. 1 were previously finalized.

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