Background on the IPFQR Program. The IPFQR Program is a pay-for-reporting program established by the Affordable Care Act (ACA) and added to the Social Security Act. IPFs are subject to a reduction of two percentage points in their annual payment update for failure to meet administrative and data reporting requirements on certain quality measures. Our current IPFQR Program measure set includes 14 measures. CMS proposes to increase the IPFQR Program measure set to 16 measures by proposing the addition of five measures and the removal of three measures. The proposed rule also proposes several policies that would lessen the burden on reporting entities.
Measures Proposed for Adoption for FY 2018 Payment Determination and Subsequent Years
• One Tobacco Treatment Measure. TOB-3 - Tobacco Use Treatment Provided or Offered at Discharge and a subset measure TOB-3a Tobacco Use Treatment at Discharge (NQF #1656) measures patients 18 and older who have used tobacco products and who were referred to counseling and received or refused a prescription for cessation medication upon discharge, and the subset measure includes only those patients who received counseling and cessation medication at discharge.
• One Substance Use Measure. SUB-2 - Alcohol Use Brief Intervention Provided or Offered and a subset measure SUB-2a Alcohol Use Brief Intervention (NQF #1663) measures patients 18 and older to whom a brief substance-abuse intervention was provided, or offered and refused, and the subset measure includes only those patients who received a brief intervention.
• Two Transition Record Measures.
• Transition Record with Specified Elements Received by Discharged Patients (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0647) measures the percentage of patients discharged from an inpatient facility, or their caregivers, who received a transition record with specified elements at the time of discharge.
• Timely Transmission of Transition Record (Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care) (NQF #0648) measures the percentage of patients discharged from an inpatient facility for whom a transition record was transmitted to the health care setting designated for follow-up care within 24 hours of discharge.
• One Screening for Metabolic Disorders Measure. Screening for Metabolic Disorders measures the percentage of discharges with an antipsychotic prescription for which a structured metabolic screening for (1) BMI; (2) blood pressure; (3) glucose or HbA1c; and (4) a lipid panel elements was completed in the past year.
Measures Proposed for Removal
Beginning with FY 2017 Payment Determination. HBIPS 4 (Patients Discharged on Multiple Antipsychotic Medications) is proposed for removal due to the loss of NQF endorsement, and because CMS believes that HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification sufficiently includes the data that HBIPS-4 was intended to collect.
Beginning with FY 2018 Payment Determination. HBIPS 6 (Post-Discharge Continuing Care Plan Created) and HBIPS 7 (Post-Discharge Continuing Care Plan Transmitted to Next Level of Care Provider Upon Discharge) because these measures would be duplicative of two measures CMS is proposing for FY 2018 and the measures proposed for removal are not as robust as the proposed new measures.
Other Changes CMS is also proposing changes to the data reporting requirements for IPFQR Program measures. Specifically, CMS is proposing to require IPFs to report measure data as a single, yearly count rather than by quarter and age because obtaining data for each quarter and by age is burdensome to providers and the resultant number of cases is often too small to allow public reporting. In addition, CMS is proposing to require IPFs to report aggregate population counts for discharges as a single, yearly count rather than by quarter. CMS is also proposing to change sampling requirements to give providers the option of obtaining one global sample for most measures, rather than having different sampling requirements for different measures. CMS believes that uniform sampling will decrease provider burden and allow streamlined procedures.
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