How IPPS Proposed Rules Would Affect Quality Measures

2. Pay for reporting of unplanned, any-cause hospital-wide readmissions.
Because readmissions for any cause within 30 days cost Medicare an estimated $17 billion annually and affect nearly one in five beneficiaries, and because currently measured readmissions reflect only those for patients with pneumonia, heart failure and heart attack, CMS seeks to expand the categories for reporting for which it pays hospitals an incentive of 2%.

Under a separate section of the Affordable Care Act, hospitals with higher rates of readmissions of patients with any of these three conditions are already penalized between 1% and 3% of their Medicare DRG payments, but many hospitals don't have enough of those patients for a fair comparison.

This new readmission metric, which would affect payments as of Oct. 1, 2014, would provide "a broader sense of the quality of care in hospitals," the agency said. CMS says that successful programs have reduced these all-cause readmission rates between 20% and 40%.

Readmissions would be counted as a single score for medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology procedures.

Addressing one controversial aspect, CMS would exclude 36 procedure categories for which a readmission may have been reasonably expected or planned.

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