Joint Commission Releases List of Top Performers

The Joint Commission’s newly released annual report on hospital quality shows hospitals continue to perform well on quality accountability measures. The report noted that Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance.

 

Nearly 37 percent of the 3,300 Joint Commission hospitals were designated Top Performer on Key Quality Measures, an 11 percent increase from last year. In addition to the 1,224 hospitals receiving Top Performer designation, 718 hospitals missed achieving the designation by only a slight margin, according to the report.

 

Hospital performance was evaluated on 46 accountability measures. A statement released by The Joint Commission noted that the data demonstrate “the nationwide implementation of evidence-based quality improvement processes is working.”

 

But quality experts and consumer groups have expressed concern with the Top Performer designation. Their concerns center on using process rather than clinical outcome measures such as how many patients died or had to be readmitted to the hospital within 30 days of receiving care. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)

 

Lisa McGiffert of the Safe Patient Project said, “When we reward hospitals or give them accolades, it should be based on something a little more concrete.” It may be misleading to patients to focus on organizations that have proved they regularly follow standards of care or protocols, she added, even though processes are meaningful internally to hospitals as they track how efficiently they provide care.

 

Critics acknowledge that process measures are much easier to measure than outcomes, but tracking a hospital’s adherence to set standards really doesn’t have a lot to do with how patients turn out, and it’s not really a true measure of the quality of a hospital, noted the author of the Skeptical Scalpel blog.

 

This has been an ongoing complaint about The Joint Commission. Its CEO defended the report and the Top Performer designation by noting that the process measures were selected based on evidence that they drive better outcomes and have clear steps hospitals can follow to achieve them. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)

 

“I understand the argument consumer groups are making, and moving in the direction of more outcome measures is right,” said Dr. Robert Wachter, a leading quality and safety expert and associate chairman of the department of medicine at UCSF Medical Center in San Francisco. But until the science catches up with the demand, the right thing for the Joint Commission and others to do is use a thoughtful combination of hospital process, outcome and structural measures (such as having an electronic health record) to make assessments. (“Are Joint Commission ‘Top Performers’ enjoying grade inflation?” Modern Healthcare, November 14, 2014)

 

More about the report can be found here.

 

 

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Outpatient and Ambulatory Surgery Rates to Increase in 2015

Hospital Outpatient Prospective Payment System (OPPS) rates will increase by 2.3 percent and ambulatory surgical center (ASC) rates will increase by 1.4 percent in 2015, according to the final rule released by CMS in late October. The rate increases are more than originally proposed by CMS and are expected to affect more than 4,000 hospitals and about 5,300 ASCs.

 

The final rule included implementation of comprehensive ambulatory payment classifications (C-APCs). These classifications provide a single payment for all related or adjunctive hospital items and services provided to a patient receiving device-dependent primary procedures.

 

The final rule dropped three of the C-APCs CMS had proposed to receive a single comprehensive payment for services. CMS wrote in its fact sheet that these three APCs were eliminated, “because a significant number of higher cost non-comprehensive services are often performed with the services assigned to these APCs, and a single payment for the comprehensive service would result in significant underpayment for these select procedure combinations.”

 

Policy Changes

 

The final rule outlined hospital OPPS policy changes. Some of the policy changes include:

 

  • Requires physician certification only for outlier cases and long-stay cases of 20 days or more. However, CMS will continue to require narrower admission orders for all inpatient admissions when a patient has been formally admitted as an inpatient of the hospital.

 

  • “Conditionally” packages all ancillary services assigned to APCs with a geometric mean cost of $100 or less into a single payment for the primary service. Ancillary services will be eligible for separate payment if they are furnished by themselves. The final rule provides exceptions to the ancillary services packaging policy for preventative, psychiatric, and drug administration services, according to the fact sheet.

 

  • Packages prosthetic supplies as are implantable prosthetic devices and all other supplies in the OPPS when used in conjunction with a surgical or other procedure. Replacement prosthetic supplies associated with an implantable prosthetic device would continue to be available outside of the hospital through the durable medical equipment prosthetic and orthotics supplies fee schedule.

 

  • Limits OPPS outlier payments to services costing more than the multiple threshold of 1.75 times the APC payment rate and exceeding the 2015 fixed dollar threshold of the APC payment plus $2,775. An estimated 1 percent of total OPPS on outlier payments will be affected by the change.

 

  • Establishes a process to recover overpayments inked to erroneous payment data submitted by Medicare Advantage organizations or Part D prescription drug plan sponsors. Payment recovery will be limited to specific circumstances, and the program includes an appeals process.

 

The final rule generally is effective on January 1, 2015. Comments on the final rule are due December 30.

 

Sources: “Hospital Outpatient, Ambulatory Pay Jumps,” HFMA Weekly News, November 7, 2014); “CMS Final Rule Increases OPPS Payments by 2.3% in 2015,” AHLA Weekly, November 7, 2014)

 

For a complete description of the changes, please read the CMS fact sheet.

 

 

 

iProtean subscribers, Governance of Integrated Delivery Systems is in your library. Featuring noted governance experts Barry Bader and Pam Knecht, this course focuses on the changes in governance necessitated by structural changes within healthcare, specifically the move to integrated delivery/care systems. Specific topics include key changes in governance, changes in governance structure, best practices and the role of local/subsidiary boards.

 

 

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Price Increases, Not Utilization, Drove Up Healthcare Spending in 2013

Rising prices, not increased utilization, drove increased spending on acute inpatient care, outpatient care and brand prescriptions, according to the Health Care Cost Institute’s 2013 Health Care Cost and Utilization Report. Healthcare spending increased an average 3.9 percent in 2013.

 

Since 2010, health spending per insured person has grown by an average of 3.9 percent per year, considerably slower than historical expenditure growth for this population.

 

Some specific details noted in the report include:

 

  • Healthcare spending averaged $4,864 per individual covered by employer-sponsored insurance ($183 more than in 2012)
  • Acute inpatient care spending increased 3.9 percent
  • Spending for professional procedures increased 3.3 percent
  • Out-of-pocked spending increased 4 percent
  • Outpatient services spending increased by 5.2 percent
  • Prescription drug spending increased by 3.1 percent

 

Utilization decreased across a broad range of services. Specifically:

 

  • Use of brand prescription drugs, inpatient admissions and outpatient services declined in 2013. However, average prices increased for all three categories, and at higher rates than in 2012.
  • Acute inpatient admissions per 1,000 declined 2.3 percent due to a 5.1 percent drop in medical and 3.7 percent drop in surgical admissions per 1,000 insured patients.
  • A 0.8 percent reduction in outpatient visits was driven by declines in outpatient surgery and emergency department visits.

 

Healthcare spending was similar in 2013 to the previous two years, the report authors noted. “In each of those years, rising medical and brand prescription prices led to spending growth,” the report stated. “However, unlike in 2011 and 2012, declining utilization in 2013 offset price increases, keeping expenditure growth historically slow.” (2013 Health Care Cost and Utilization Report, Health Care Cost Institute, October 2014)

 

For a copy of the report, please click here.

 

 

Additional source: “Report: Prices Drive 3.9 Percent Increase in Healthcare Spending,” HFMA Weekly News, October 31. 2014

 

 

iProtean subscribers, Governance of Integrated Delivery Systems is in your library. Featuring noted governance experts Barry Bader and Pam Knecht, this course focuses on the changes in governance necessitated by structural changes within healthcare, specifically the move to integrated delivery/care systems. Specific topics include key changes in governance, changes in governance structure, best practices and the role of local/subsidiary boards.

 

 

For a complete list of iProtean courses, click here.

 

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