Hospital Inpatient Quality Reporting Program
The Hospital Inpatient Quality Reporting Program is a pay-for-reporting quality program that reduces payments to hospitals that do not meet program requirements. Hospitals that do not submit quality data or do not meet all Hospital Inpatient Quality Reporting Program requirements are subject to a one-fourth reduction in their Annual Payment Update under the IPPS.
CMS is proposing to adopt three new measures:
- Excess Days in Acute Care After Hospitalization for Diabetes measure beginning with the FY 2029 payment determination.
- Hospital Harm-Postoperative Venous Thromboembolism electronic clinical quality measure (eCQM) beginning with the FY 2030 payment determination.
- Advance Care Planning eCQM beginning with the FY 2030 payment determination.
CMS is proposing to adopt five modified mortality measures, beginning with the FY 2028 payment determination, before moving the modified versions to the Hospital Value-Based Purchasing Program. Modifications include adding Medicare Advantage patients and shortening the performance period from 3 years to 2 years:
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Acute Myocardial Infarction (AMI) Hospitalization measure.
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Heart Failure Hospitalization measure.
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia Hospitalization measure.
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Chronic Obstructive Pulmonary Disease (COPD) Hospitalization measure.
- Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Coronary Artery Bypass Graft (CABG) Surgery measure.
CMS is proposing modifications to three measures beginning with the FY 2028 payment determination. Modifications include adding Medicare Advantage patients and shortening the performance period from 3 years to 2 years:
- Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction.
- Excess Days in Acute Care after Hospitalization for Heart Failure.
- Excess Days in Acute Care after Hospitalization for Pneumonia.
CMS is proposing to remove three measures beginning with the FY 2030 payment determination:
- Venous Thromboembolism Prophylaxis (VTE-1) eCQM.
- Intensive Care Unit Venous Thromboembolism Prophylaxis (VTE-2) eCQM.
- Discharged on Antithrombotic Therapy (STK-02) eCQM.
CMS is also proposing changes to the data reporting and submission requirements for some eCQMs and structural measures, specifically:
- Mandatory reporting for the Malnutrition Care Score eCQM beginning with the FY 2030 payment determination.
- Establishing a mandatory reporting policy to make hospital harm eCQMs mandatory after two years of reporting beginning with the FY 2030 payment determination.
- An update to the reporting of the Maternal Morbidity Structural measure beginning with the FY 2028 payment determination to identify which perinatal quality collaborative program the hospital participates in.
PCH Quality Reporting Program
The PPS-Exempt Cancer Hospital (PCH) Quality Reporting Program is a quality reporting program for the eleven cancer hospitals that are statutorily exempt from the IPPS. CMS collects and publishes data from PCHs on applicable quality measures.
In the FY 2027 IPPS proposed rule, CMS is proposing to adopt two new measures beginning with the FY 2030 program year:
- Advance Care Planning eCQM.
- Malnutrition Care Score eCQM.
CMS is also proposing to remove the COVID–19 Vaccination Coverage Among Healthcare Personnel measure beginning with the FY 2028 program year. Finally, CMS is proposing to establish reporting and submission requirements for eCQMs in the PCH setting.
Next week, we will provide a final article concerning the contents of the 2027 IPPS proposed rule.