How IPPS Proposed Rules Would Affect Quality Measures

3. The number of elective hip and/or knee arthroscopic surgeries that resulted in complications or readmissions.
Complication rates for these ubiquitous procedures range from 2.2% to 8.9%, which indicates to CMS that important quality differences among hospitals providing these surgeries are pervasive.

CMS proposes to measure outcomes such as death, pulmonary embolism, surgical site bleeding, or wound infection within 30 days of admission; heart attack, pneumonia or sepsis occurring within seven days of admission; and mechanical complications and periprosthetic joint infections within 90 days of admission.

CMS wants to track these complications because the number of these procedures—202,500 total hip and 402,100 total knee in 2003—continues to grow with a projected annual charge to Medicare estimated at $58 billion by 2015.  "The post-operation complications of these procedures are high considering these are selective procedures and usually the complications are devastating to patients."

CMS also plans to add the number of times patients who underwent a hip or knee surgery required a readmission within 30 days to the pay for reporting program effective for discharges as of Oct. 1, 2014.

Readmission rates for these procedures range from 3.06% to 50.94%, a variation that "suggests there are important differences in the quality of care received across hospitals, and there is room for improvement," the agency said.

4. Elective pre-term deliveries between 37 and 39 weeks of gestation that weren't medically necessary.
Saying that early elective deliveries are "a growing public health problem" that increases the likelihood of complications and long-term health problems for mother and baby, CMS officials say they want to start collecting hospital data starting Jan. 1. Results would be reflected in payment as of Oct. 1, 2014.

Pre-term births, many of which that take place simply for the convenience of the physician, hospital or parent, have increased by 36% over the last two decades.  CMS is concerned because Medicare last year paid for 14,000 births among beneficiaries" who have the potential to be impacted by pre-term births."

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