Hospitals Reporting Quality Data Could Get Higher Reimbursement

Acute-care hospitals that report selected quality data will receive a 3.7 percent increase in payment for inpatient services under a final rule issued by the Centers for Medicare and Medicaid Services (CMS).

Only hospitals participating in Medicare's quality reporting initiative will receive the full increase. Nonparticipating hospitals will receive only a 3.3 percent increase in payment rates. As in 2005, however, most acute-care hospitals are expected to participate in the quality reporting program in 2006, according to CMS.

To receive the full payment for Fiscal 2006, hospitals must correctly abstract and report clinical data on 10 quality measures relating to the treatment of heart attack, heart failure, and pneumonia cases for two consecutive calendar quarters.

CMS has reviewed the hospitals' data submissions and determined that nearly all hospitals were able to meet the quality standards that are being adopted in the final rule. Many hospitals are now reporting 17 quality measures for these three conditions, according to CMS.

“We have taken steps to improve care through quality measures, because it is important not only to the health of our beneficiaries, but for avoiding unnecessary health care spending,” said CMS Administrator Mark McClellan, M.D., Ph.D. “For example, CMS recently announced our participation in a national quality partnership, the Surgical Care Improvement Project, which has set as its goal a 25 percent reduction in surgical complications by 2010. As we find new ways to improve health care outcomes, we can anticipate reduced spending on the treatment of complications.”▪