American Hospital Association Inpatient Psychiatric Quality Reporting Program

Agenda Requirements of the Inpatient Psychiatric Facility Quality Reporting Program (IPFQRP) Proposed Measures Reporting Quality Data Getting Your Input For those at the last round of RPBS we went over the basics of the VPB program and CMS’ proposed rule. Starts in 2013 with 1 percent of payments set aside for VBP. Only IPPS hospitals and doesn’t affect special payments.

MB – 2.0 for Failure to Report Overall Financials Section 3401 of the Affordable Care Act Affordable Care Act Policy Fiscal Year 2014 2015 2016 Inpatient Psychiatric Facility Quality Reporting Program MB – 2.0 for Failure to Report Burden 820 hours/year For those at the last round of RPBS we went over the basics of the VPB program and CMS’ proposed rule. Starts in 2013 with 1 percent of payments set aside for VBP. Only IPPS hospitals and doesn’t affect special payments.

IPF Quality Reporting Begins no later than October 1, 2013 Measures must be published no later than October 1, 2012 Public reporting of data   Also in the IPPS rule will be the proposed measures for the ACA-mandated readmission reduction program which will cut payments to hospitals by up to 1% in FY 2013. This readmission measures that will be used for the program were determined last year and include readmissions for heart attack, heart failure, and pneumonia. This year’s rule could include proposals for other types of readmission measures. We will be looking for whether CMS proposes any changes to better adjust the payment adjustments to better reflect and exclude readmissions that were planned and unrelated. We’ll also be looking for the specific payment details.

Existing IPF Quality Reporting 450 IPFs report quality data as a condition of accreditation by The Joint Commission (TJC) Hospital-Based Inpatient Psychiatric Services (HBIPS) An estimated 1,100 IPFs, who are not TJC accredited, are not currently reporting quality measures   Also in the IPPS rule will be the proposed measures for the ACA-mandated readmission reduction program which will cut payments to hospitals by up to 1% in FY 2013. This readmission measures that will be used for the program were determined last year and include readmissions for heart attack, heart failure, and pneumonia. This year’s rule could include proposals for other types of readmission measures. We will be looking for whether CMS proposes any changes to better adjust the payment adjustments to better reflect and exclude readmissions that were planned and unrelated. We’ll also be looking for the specific payment details.

Proposed IPF Quality Measures Hours of physical restraint Hours of seclusion use   Hours of physical restraint. This measure captures the total number of hours for all psychiatric inpatients who are maintained in physical restraint divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.   Hours of seclusion use. This measure captures the total number of hours for all psychiatric inpatients held in seclusion divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.

Proposed IPF Quality Measures Patients discharged on multiple antipsychotic medications medications with appropriate justification   Patients discharged on multiple antipsychotic medications. This proposed measure would capture those psychiatric inpatients discharged on two or more routinely scheduled antipsychotic medications divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.   Patients discharged on multiple antipsychotic medications with appropriate justification. This proposed measure captures those psychiatric inpatients discharged on two or more routinely scheduled antipsychotic medications with appropriate justification divided by the total number of psychiatric inpatient hours. TJC has identified the following justifications as appropriate reasons for discharging a patient on multiple antipsychotics: Medical record contains documentation of a history of a minimum of three failed trials of monotherapy; Medical record contains documentation of a recommended plan to taper to monotherapy or documentation of a plan to decrease the dosage of one or more antipsychotic medications while increasing the dosage of another antipsychotic medication to a level that manages the patient’s symptoms with one antipsychotic medication (that is, cross-taper); and Medical record contains documentation of augmentation of Clozapine.

Proposed IPF Quality Measures Creation of a post-discharge continuing care plan Post-discharge continuing care plan transmission to next level of care provider upon discharge   Creation of a post-discharge continuing care plan. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan is created and contains all of the following: reason for hospitalization, principal discharge diagnosis, discharge medications, and next level of care recommendations divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.   Post-discharge continuing care plan transmission to next level of care provider upon discharge. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan was transmitted to the next level of care divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.

Proposed Measurement Domains Measure Domain Measure Patient Safety Hours of physical restraint use Hours of seclusion use Clinical Quality of Care Patients discharged on multiple antipsychotic medications Patients discharged on multiple antipsychotic medications with appropriate justification Care Coordination Post-discharge continuing care plan created Post-discharge continuing care plan transmitted to next level of care provider upon discharge Creation of a post-discharge continuing care plan. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan is created and contains all of the following: reason for hospitalization, principal discharge diagnosis, discharge medications, and next level of care recommendations divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.   Post-discharge continuing care plan transmission to next level of care provider upon discharge. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan was transmitted to the next level of care divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.

Collection of Quality Data Aggregate data must be reported Numerator, denominator and exclusions   Fiscal Year Reporting Period Submission Period Preview Period 2014 Oct 1, 2012 – March 31, 2013 July 1 – Aug 15, 2013 Sept 20 – Oct 19, 2013 2015 April 1 – Dec 31, 2013 July 1 – Aug 15, 2014 Sept 20 – Oct 19, 2014 2016 Jan 1 – Dec 31, 2015 July 1 – Aug 15, 2015 Sept 20 – Oct 19, 2015 Creation of a post-discharge continuing care plan. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan is created and contains all of the following: reason for hospitalization, principal discharge diagnosis, discharge medications, and next level of care recommendations divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.   Post-discharge continuing care plan transmission to next level of care provider upon discharge. This proposed measure captures those psychiatric inpatients for whom the post-discharge continuing care plan was transmitted to the next level of care divided by the total number of psychiatric inpatient hours. This measure is NQF-endorsed and was recommended by the MAP.

Readmissions Reduction Program Readmissions Reduction Program What can hospitals do next? Download feedback reports Available on QNet by 6/20/12 Analysis of your patient population Planned/unplanned and related/unrelated Patient characteristics   Also in the IPPS rule will be the proposed measures for the ACA-mandated readmission reduction program which will cut payments to hospitals by up to 1% in FY 2013. This readmission measures that will be used for the program were determined last year and include readmissions for heart attack, heart failure, and pneumonia. This year’s rule could include proposals for other types of readmission measures. We will be looking for whether CMS proposes any changes to better adjust the payment adjustments to better reflect and exclude readmissions that were planned and unrelated. We’ll also be looking for the specific payment details.

Readmissions Reduction Program Getting Your Input Readmissions Reduction Program If you have experience reporting these measures, do you feel they appropriately target gaps in care?  What concerns do you have with the proposed requirements for the IPFQRP?   Also in the IPPS rule will be the proposed measures for the ACA-mandated readmission reduction program which will cut payments to hospitals by up to 1% in FY 2013. This readmission measures that will be used for the program were determined last year and include readmissions for heart attack, heart failure, and pneumonia. This year’s rule could include proposals for other types of readmission measures. We will be looking for whether CMS proposes any changes to better adjust the payment adjustments to better reflect and exclude readmissions that were planned and unrelated. We’ll also be looking for the specific payment details.