Over the last two weeks, we have presented our readers a summary of provisions found in the FY 2025 Medicare Inpatient Prospective Payment System (IPPS) proposed rule. Last week, we introduced some of the quality programs. Today’s article takes a look at additional reporting programs that hospital administrators will need to consider.

Hospital Readmissions Reduction Program

The Hospital Readmissions Reduction Program is a value-based purchasing program that reduces payments to hospitals with excess readmissions. It also supports the goal of the Centers for Medicare and Medicaid Services (CMS) to improve healthcare for patients by linking payment to the quality of hospital care.

CMS is not proposing any changes to the Hospital Readmissions Reduction Program in the proposed rule. It should be noted that all previously finalized policies under this program will continue to apply. For further information on these policies, readers are directed to the 2023 IPPS final rule (87 FR 49081 through 49094).

Hospital-Acquired Condition Reduction Program

The Hospital-Acquired Condition (HAC) Reduction Program creates an incentive for hospitals to reduce the incidence of hospital-acquired conditions by reducing payment by one percent for applicable hospitals that rank in the worst-performing quartile on select measures of hospital-acquired conditions.

CMS is not proposing any changes to the HAC Reduction Program in the FY 2025 IPPS proposed rule. All previously finalized policies under this program will continue to apply. See the 2024 IPPS final rule (88 FR 59108 through 59114) for further information on these policies.

Hospital Value-Based Purchasing (VBP) Program

The Hospital Value-Based Purchasing (VBP) Program is a budget-neutral program funded by reducing participating hospitals’ base operating DRG payments each fiscal year by two percent and redistributing the entire amount back to the hospitals as value-based incentive payments. In the FY 2025 IPPS proposed rule, CMS is proposing to:

• Adopt the Patient Safety Structural measure beginning with the CY 2025 reporting period/FY 2027 program year.
• Modify the HCAHPS Survey measure beginning with the CY 2025 reporting period/FY 2027 program year. These changes are the same as mentioned in the Hospital IQR Program.
• Move up the start date for publicly displaying hospital performance on the Hospital Commitment to Health Equity measure to January 2026 or as soon as feasible thereafter.

Hospital and CAH Data Reporting

CMS is proposing to update the hospital and critical access hospital (CAH) infection prevention and control and antibiotic stewardship programs’ Conditions of Participation (CoPs) to extend a subset of the current COVID-19 and influenza data reporting requirements. Specifically, CMS is proposing to replace the COVID-19 and Seasonal Influenza reporting standards for hospitals and CAHs with a new standard that will address acute respiratory illnesses.

The new standard would require that, beginning on October 1, 2024, hospitals and CAHs would have to electronically report certain data elements about COVID-19, influenza and respiratory syncytial virus (RSV). The proposed information for which reporting would be required includes confirmed infections of respiratory illnesses, including COVID-19, influenza and RSV, among hospitalized patients; hospital bed census and capacity; and limited patient demographic information, including age. CMS is proposing that, outside of a public health emergency (PHE), hospitals and CAHs would have to report these data on a weekly basis.

CMS also recognizes that, while necessary, these data may not be sufficient during an actual emergency scenario. Accordingly, CMS is also proposing that, in the event of a declared national PHE for an acute respiratory illness, there may be additional categories of reporting required, such as: facility structure and infrastructure operational status; hospital/ED diversion status; staffing and staffing shortages; supply inventory shortages; and relevant medical countermeasures and therapeutics.

For a full treatment of the proposed rule please visit the following website: https://www.federalregister.gov/public-inspection/2024-07567/medicare-and-medicaid-programs-and-the-childrens-health-insurance-program-hospital-inpatient.