1. American Hospital Association
Inpatient Psychiatric Quality Reporting Program

2. 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.

3. 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.

4. 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 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.

5. 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 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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 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.

12. 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 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.