View From Washington – One Size Does Not Fit All

Looking at the CMS Quality Data Reporting Initiative and the implications for specialty hospitals.

Health policy experts recognize that quality and transparency within healthcare are proving to be a significant regulatory activity of the administration in 2008. Providing the best quality of care is one thing upon which all facets of the healthcare industry can agree, yet, how best to achieve that goal reveals cracks in that accord. Nowhere is this more evident than in the seemingly innocuous introduction of quality measurement reporting for hospital outpatient procedures.

On Nov. 1, 2007, the Centers for Medicare & Medicaid Services (CMS) released a final rule of the Outpatient Prospective Payment System (OPPS), which introduced the initial implementation of the Hospital Outpatient Quality Data Reporting Program (HOP QDRP). This new program encourages hospitals to improve their quality of care, and stems from previous efforts within the inpatient arena. Hospitals will report on standardized measures on the quality of outpatient care for 2008 services in order to receive the full annual update to their OPPS payment rate. Failure to participate in the program will make hospitals subject to a 2 percent cut in OPPS payments beginning in calendar year 2009.

This recent effort of data reporting for the hospitals begins with seven specific measures that each hospital must record in order to avoid the cut in OPPS payments. These first measures deal mostly with heart-related conditions. Clearly, some measures will prove more applicable to general acute care hospitals, as they deal with a wider range of cases. However, questions have crept up over the implications of these specific quality measures for hospitals that specialize. CMS has indicated that the program will grow, and as more measures are added they will address different issues. Yet, specialty hospitals that do not routinely deal with the specified conditions, and have little potential for ever dealing with such cases, are left to wonder what this initiative ultimately means for them.

To be determined
CMS has stated that other to-be-determined measures will require reporting in future cycles. Given this fact, specialty hospitals are concerned about when those measures will come, and what those measures will be. Many specialty hospitals will want some involvement in the development of quality measures intended for their type of facility, in an attempt to establish more relevant and effective quality measures. However, it is easy to suspect that a “one-size fits all” approach may be the order of the day for CMS moving forward.

To be more relevant to hospitals that specialize, the process for creating additional quality measures in the future must include a component to identify best practices within these facilities. Using basic outcome measures to determine best practices within a given field of expertise is one way to prepare before establishing new measures. Perhaps there should be attempts by policymakers to identify best practices within a specialty, and involve clinical experts from these hospitals to help interpret how best to apply that information into creating new quality measures.

Of course, reporting for general acute care hospitals is essential in the efforts to improve quality outcomes. Nevertheless, the movement to improve quality of care will be better served and better realized alongside a greater awareness by the government of the unique attributes that specialty hospitals exhibit.

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