HFMA’s Regulatory Sound Bites

An Overview of the Final 2013 Inpatient Prospective Payment Rule

Dear Member,

This presentation provides a summary of recent regulatory acts and highlights the features that most affect acute care hospitals. It also offers a guide to HFMA resources you can use to navigate your organization through the complicated economic and regulatory environment.

Please feel free to use this presentation to educate your staff and other hospital stakeholders. If HFMA can be of additional assistance in any way, please do not hesitate to contact us.

Warmest Regards,

HFMA

Review the 2013 Final Medicare Inpatient Prospective Payment Rule

Analyze Implications for HospitalsIdentify HFMA Resources for

Addressing These Changes

Presentation Objectives

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2.30%2.50% 2.60%

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Positive ImpactThe Final Rule Increases Payments to All Hospitals

Reimbursement Impact of the 2013 Final IPPS Rule

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Source, pp. http://www.ofr.gov/OFRUpload/OFRData/2012-19079_PI.pdf pgs 1881-1886

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Operating Base RatesCMS Is Adjusting the Market-Basket Update for Upcoding Related to MS-DRG Implementation

IPPS Provisions

• The 2013 final MBU is

•The market basket rate-of-increase of 2.6% will be reduced further by an adjustment of 0.7% for the multifactor productivity adjustment, less 0.1% (both mandated by the ACA), resulting in a net payment increase of 1.8 percent.

2.6% for hospitals submitting quality data

0.2% for hospitals not submitting quality data

• The rate increase will increase hospital payments by an estimated $2.0 billion in FY13, or 2.3 percent.

• Additional reductions are anticipated. Providers should look for opportunities to reduce waste inefficiencies.

Implications for Hospitals

Notes:1. See Appendix 1 for final operating rates

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Capital Base Rates and Payments Capital Payments Are Increased by an Estimated 1.2%

IPPS Provisions• CMS establishing an update of 1.2%

in determining the FY13 capital federal rate for all hospitals

• CMS not adopting proposal to make an additional -0.8% adjustment to the national capital rate in FY13 to adjust for upcoding as a result of MS-DRG implementation

• Capital rate established at $425.49 for FY13, based on 1.2 % update and other budget neutrality factors

Implications for Hospitals

Notes:1. See Appendix 2 for calculation of FY13 standard federal capital rates

• Additional negative adjustments for documentation and coding should be anticipated

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• The final outlier fixed-loss cost threshold for FY13 will decrease to $21,821, from the current amount of $23,630.

• CMS using same methodology it proposed to calculate the outlier threshold for FY13, using cases from the FY11 MedPAR file (the most recent data available at the time of this final rule)

• Hospital VBP and readmissions payment adjustments excluded from this calculation

• For FY13, a case would qualify as a cost outlier if the cost for the case plus the (operating) IME and DSH payments is greater than the prospective payment rate for the MS-DRG, plus the fixed loss amount of $21,821

• Facilities need to model these changes to understand the full financial impact on revenue

Outlier Payments

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Quality Data for Payment Update• For FY14, CMS suspended data collection for four measures beginning with January 1, 2012, discharges, affecting the FY14 payment determination and subsequent years

• These measures include:

Acute Myocardial Infarction (AMI) o AMI-1 Aspirin at arrival o AMI-3 ACEI/ARB for left ventricular systolic dysfunction o AMI-5 Beta-blocker prescribed at discharge

Surgical Care Improvement Project (SCIP) o SCIP INF-6 Appropriate Hair Removal

• CMS says the suspension of data collection for these four measures will be continued unless it has evidence that performance on the measures is in danger of declining

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Quality Data for Payment UpdateThe rule finalizes a total of 59 measures for FY15 and subsequent years

Implications for Hospitals

Notes:See Appendix 3 for FY15 Hospital IQR quality measures

• Providers should make sure they can collect and submit the additional quality measures

• Processes should be in place to improve performance for each measure

IPPS Provisions

• For FY15 CMS adopting all Hospital IQR Program measures adopted in previous payment determinations, with the exception of the 17 measures

Measures that CMS is removing include:

1 chart-abstracted measure 16 claims-based measures

• For FY15, and subsequent years, the 59 measures that CMS is finalizing include:

New survey-based measure items for inclusion in the HCAHPS survey measure3 claims-based measures1 chart-abstracted measure

• Total of 59 measures for the FY15 payment determination and subsequent years

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Quality Data for Payment Update

• HCAHPS survey measure: NQF-endorsed 3-Item Care Transition Measure (CTM-3) (NQF #0228)

• Three claims-based measures:

Hip/Knee Complication: Hospital-level risk-standardized complication rate (RSCR) following elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) (NQF#1550)

Hip/Knee Readmission: Hospital-Level 30-Day All-Cause Risk-Standardized Readmission Rate (RSRR) Following Elective Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) (NQF #1551)

Hospital-Wide Readmission (tentative NQF #1789)

• New Chart-Abstracted Measure: Elective Delivery Prior to 39 Completed Weeks Gestation: Percentage of babies electively delivered prior to 39 completed weeks gestation (NQF #0469)

Additional IQR Program Measures for FY15

IQR Program Measures for the FY16

• CMS adopted the Safe Surgery Checklist Use measure for FY16

• not NQF-endorsed

• Structural measure assesses whether a hospital outpatient department utilizes a Safe Surgery checklist that assesses whether effective communication and safe practices are performed during three distinct perioperative periods:

prior to the administration of anesthesia

prior to skin incision period of closure of incision

and prior to the patient leaving operating room

• CMS is finalizing the Safe Surgery Checklist use measure for a total of 60 measures for the FY 2016 payment determination and subsequent years. .

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Wage Index

IPPS Provisions

• Providers should complete the occupational mix index survey

In the FY11 IPPS/LTCH PPS proposed rule and final rule, beginning with the new 2010 occupational mix survey, CMS required hospitals that do not submit occupational mix data to provide an explanation for not complying.

CMS instructed FIs/MACs to begin gathering this information as part of the FY13 wage index desk review process. CMS will review these data for future analysis and consideration of potential penalties for noncompliant hospitals.

Implications for Hospitals

The FY13 wage index values are based on the data collected from the Medicare cost reports submitted by hospitals for cost reporting periods beginning in FY09 (the FY12 wage indices were based on data from cost reporting periods beginning during FY08)

• For FY13, the wage index will continue to be calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located

• CMS defines hospital labor market areas based on the Core-Based Statistical Areas (CBSAs)

• The FY13 national average hourly wage (unadjusted for occupational mix) is $37.4855

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Hospital Readmissions Reduction

• The Hospital Readmissions Reduction Program requires a reduction to a hospital’s base operating DRG payment amount to account for excess readmissions of selected applicable conditions:

acute myocardial infarction heart failure pneumonia

• Minimum number of discharges for each applicable conditions is 25

• Provision not budget neutral

• For FY13, readmission payment adjustment is the higher of ratio of a hospital’s aggregate dollars for excess readmissions to their aggregate dollars for all discharges, or 0.99 (that is, or a 1-percent reduction)

• Program will result in an estimated 0.3 percent decrease, or $280 million, in payments to hospitals

• Secretary can expand the conditions for the program in FY15

• CMS finalized 3 years (7/1/08 to 6/30/11) as the applicable period for the FY13 payment adjustment

• Hospitals should work to understand the readmission drivers within their patient population and put programs in place to mitigate these issues.

IPPS Provisions Implications for Hospitals

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Value Based Purchasing • Under Hospital Value-based Purchasing Program (VBP), value-based incentive

payments are made in a fiscal year to hospitals that meet performance standards established for a performance period for such fiscal year.

• ACA directs the Secretary to begin making value-based incentive payments under the Hospital Inpatient VBP Program for discharges occurring on or after October 1, 2012.

• Incentive payments will be funded for FY13 through a reduction to the FY13 base operating MS-DRG payment for each applicable hospital’s discharge of 1%.

The applicable percentage for FY14 is 1.25% The applicable percentage for FY15 is 1.5% The applicable percentage for FY16 is 1.75% The applicable percentage for FY17 and subsequent years is 2%

• For the FY13 Hospital VBP Program, CMS previously adopted 13 measures, including 12 clinical process of care measures and a 13th measure comprising 8 dimensions from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS). The 13 measures were categorized into two domains.

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Value Based Purchasing • CMS grouped the 12 clinical process of care measures into a Clinical Process of Care

domain, and placed the HCAHPS survey measure into a Patient Experience of Care domain.

• CMS adopted a 3-quarter performance period from July 1, 2011, through March 31, 2012, for these measures and performance standards on which hospital performance will be evaluated.

• To determine whether a hospital meets or exceeds the performance standards for these measures, CMS will assess each hospital’s achievement and improvement during the period as compared with its performance during a 3-quarter baseline period from July 1, 2009, through March 31, 2010.

• CMS will then calculate a total performance score (TPS) for each hospital by combining the greater of the hospital’s achievement or improvement points for each measure to determine a score for each domain, weighting each domain score.

For the FY13 Hospital VBP Program, the weights will be clinical process of care = 70 percent, patient experience of care = 30 percent. The weighted domain scores will be added together.

• CMS will convert each hospital’s TPS into a value-based incentive payment percentage using a linear exchange function and then convert the value-based incentive payment percentage into a per

discharge value-based incentive payment amount.

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Value Based Purchasing • For FY14, CMS has adopted 17 measures for the Hospital VBP Program, including:

12 clinical process of care measures from FY13 Hospital VBP Program and the HCAHPS measure adopted for the FY13 Hospital VBP Program

1 new clinical process of care measure (SCIP-Inf-9: Postoperative Urinary Catheter Removal on Postoperative Day 1 or 2)

3 mortality outcome measures (Acute Myocardial Infarction (AMI) 30-Day Mortality Rate, Heart Failure (HF) 30-Day Mortality Rate, Pneumonia (PN) 30-Day Mortality Rate)

•Although CMS previously adopted 8 HAC measures, 2 AHRQ composite measures, and a Medicare Spending Per Beneficiary Measure for the FY14 Hospital VBP Program, it has suspended the effective date of these measures, with the result that they will not be included

Notes:See Appendix 4 for FY14 VBP Measures

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Value Based Purchasing • For FY15, CMS will retain 12 of the 13 clinical process of care measures it adopted for the FY14 program

CMS finalizing proposal to remove SCIP-Inf-10: Surgery Patients with Perioperative Temperature Management from the FY15 Hospital VBP Program because it is “topped-out”

SCIP-VTE-1 removed from the Hospital VBP Program measure set beginning with the FY15 Hospital VBP Program

• AMI-10 not finalized for FY15 Hospital VBP Program measure because it meets CMS definition of “topped-out”

•For patient experience of care domain, CMS will retain eight dimensions of the HCAHPS survey adopted for FY13 and FY14 Hospital VBP Program

•For the outcome domain, CMS retains the three 30-day mortality measures finalized for the FY14 Hospital VBP Program

•Adopts two additional outcome measures for the Outcome domain

PSI-90, the AHRQ PSI composite measure CLABSI: Central Line-Associated Blood Stream Infection measure

• For Efficiency domain, CMS adopts one new measure:

Medicare Spending per Beneficiary measure

Notes:See Appendix 5 for FY15 VBP measures (please note that although AMI-10 is not finalized for FY15, it appears in the list of measures published in the final rule, which also appears in the appendix)

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Value Based Purchasing • CMS is not finalizing the proposal to reclassify the Hospital VBP measures into domains based on the six priorities of the National Quality Strategy in FY16. It will maintain the existing four-domain structure.

• Will include the 30-day mortality measures, AHRQ PSI composite measure, and other measures finalized for the FY15 Hospital VBP measure set (with the exception of the CLABSI measure) in the FY16 measure set.

Note: See Appendix 6 for FY15 data collection period and performance standards

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Disproportionate Share

IPPS Provisions

Implications for Hospitals

• CMS will adopt a policy that hospitals that are required to submit no pay bills for services furnished on a prepaid capitation basis by a Medicare Advantage organization, or through cost settlement with an HMO, a competitive medical plan (CMP), a health care prepayment plan (HCPP), or a demonstration, for the purpose of calculating the DSH patient percentage (DPP), must also do so within the time limits for filing claims specified at § 424.44

• Hospitals submitting claims for services provided to Medicare Advantage enrollees for additional IME and direct GME payments, and for claims for nursing or allied health education program payments, must ensure that they comply with the regulations governing time limits for filing claims at § 424.44 Under §424.44, time limits

for filing claims, for services furnished on or after January 1, 2010, the claim must be filed no later than the close of the period ending 1 calendar year after the date of service

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Disproportionate Share

• Under current policy, services furnished to a labor and delivery patient are considered to be generally payable under the IPPS, under § 412.105(b)(4), but beds where the services are furnished are not available for IPPS-level acute care hospital services

• CMS believes if patient day is counted because the services furnished are generally payable under the IPPS, the bed in which the services were furnished should be considered available for IPPS-level acute care hospital services

• CMS believes it is appropriate to extend current approach of including labor and delivery patient days in the disproportionate patient percentage of the Medicare DSH payment adjustment to rules for counting hospital beds for purposes of both the IME payment adjustment and the Medicare DSH payment adjustment

The rules for counting hospital beds for purposes of the IME payment adjustment are codified in the IME regulations at § 412.105(b), which are cross-referenced in § 412.106(a)(1)(i) for purposes of determining the DSH payment adjustment

• CMS revises the regulations at § 412.105(b)(4) to remove from the list of currently excluded beds those beds associated with ancillary labor/delivery services

• Will negatively impact IME reimbursement

Policy Change Relating to Treatment of Labor and Delivery Beds in the Calculation of the Medicare DSH Payment Adjustment and the IME Payment Adjustment

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IME/GME PaymentsIPPS Provisions Implications for

Hospitals

• Section 5503 of the ACA added new section 1886(h)(8) to the Act providing reductions in FTE resident caps for direct GME payment purposes under Medicare hospitals training fewer residents than their FTE resident caps, and to authorize a “redistribution” of the estimated number of excess FTE resident slots to other qualified hospitals

• This section amended section 1886(d)(5)(B)(v) of the Act to require application of the provisions of section 1886(h)(8) of the Act “in the same manner” to the IME FTE resident caps

• Cap-building period will increase the from 3 years to 5 years

• CMS is also finalizing the proposed methodology used to calculate a cap adjustment for an individual hospital if a new program rotates residents to more than one hospital (or hospitals)

Hospitals that can qualify for additional slots and can fill them should apply

Note:See Appendix 8 for additional information.

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IME/GME Payments

• The methodology is based on the sum of the products of the following three factors:

1. The highest total number of FTE residents trained in any program year, during the fifth year of the first new program’s existence at all of the hospitals to which the residents in that program rotate

2. The number of years in which residents are expected to complete the program, based on the minimum accredited length for each type of program

3. The ratio of the number of FTE residents in the new program that trained at the hospital over the entire 5-year period to the total number of FTE residents that trained at all hospitals over the entire 5-year period

• CMS finalizing policy under section 5503 and revising the regulations text at §413.79(n)(2)(ii) to state that if a hospital does not use all of its section 5503 cap award in its final (12-month or partial) cost report of the 5-year period beginning July 1, 2011, and ending June 30, 2016, the applicable unused slots will be removed , and the award will be reduced for portions of cost reporting periods on or after July 1, 2016. 19

New HACs

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The hospital-acquired conditions (HACs) payment policy, mandated by the Deficit Reduction Act of 2005, prevents hospitals from being paid at higher MS-DRG rate for patients with complications or major complications if the sole reason for the higher payment is the occurrence, during the beneficiary’s hospital stay, of one of the conditions on the HACs list.

CMS adding Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED) and Iatrogenic Pneumothorax with Venous Catheterization to the HAC payment provision for FY13.

CMS finalizing its proposal to add Iatrogenic Pneumothorax with Venous Catheterization with the following diagnosis code 512.1 (Iatrogenic pneumothorax) and procedure code 38.93 (Venous catheterization NEC).

CMS also adding two codes, 999.32 (Bloodstream infection due to central catheter) and 999.33 (Local infection due to central venous catheter) to the existing Vascular Catheter-Associated Infection HAC Category for FY13.

CMS is modifying its proposal to add SSI Following CIED Procedures as a HAC condition. CMS’s final policy makes SSI following CIED Procedures a sub-HAC condition within the SSI HAC category subject to the HAC payment provision for discharges occurring on or after October 1, 2012.

MDH Program Expiration

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Under Section 3124 of the ACA, Medicare dependent hospitals (MDHs) currently receive the higher of payments made under the federal standardized amount or the payments made under the federal standardized amount plus 75 percent of the difference between the federal standardized amount and the hospital-specific rate

Because MDH program is not authorized by statute beyond FY12, beginning in FY13, all hospitals that previously qualified for MDH status will no longer have MDH status and will be paid based on the federal rate

CMS will allow hospitals currently classified as Medicare dependent hospitals (MDHs) to apply for classification as sole community hospitals (SCHs) upon the expiration of the MDH program on September 30, 2012

The SCH status will be effective the day following the expiration of the MDH program

CMS believes it is difficult to quantify the payment impact of this policy because it cannot estimate the number of MDHs that will be applying for SCH status

Significant Increases/ Decreases in MS-DRGs

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MS-DRG Description

FY 2012 Weight

FY Percent

2013 Diff

Weights  682Renal Failure w MCC 1.641 1.5862 -3.34872Septicemia or severe sepsis w/o MV 96+ hours w/o MCC 1.1339 1.0988 -3.1683Renal Failure w CC 1.0183 0.9958 -2.21292Heart failure & shock w CC 1.0214 1.0034 -1.76871Septicemia or severe sepsis w/o MV 96+ hours w MCC 1.909 1.8803 -1.5

65Intracranial hemorrhage or cerebral infarction w CC 1.1485 1.1345 -1.22310Cardiac arrhythmia & conduction disorders w/o CC/MCC 0.5608 0.5541 -1.19191Chronic obstructive pulmonary disease w CC 0.9628 0.9521 -1.11309Cardiac arrhythmia & conduction disorders W CC 0.8155 0.8098 -0.7378G.I. hemorrhage w CC 1.0238 1.0168 -0.68392Esophagitis, gastroent & misc digest disorders w/o MCC 0.7421 0.7375 -0.62193Simple pneumonia & pleurisy w MCC 1.4948 1.4893 -0.37287Circulatory disorders except AMI, w card cath w/o MCC 1.0743 1.0709 -0.32194Simple pneumonia & pleurisy w CC 1.0026 0.9996 -0.3192Chronic obstructive pulmonary disease w/o CC/MCC 0.7081 0.7072 -0.13690Kidney & urinary tract infections w/o MCC 0.781 0.781 0247Perc cardiovasc proc w drug-eluting stent w/o MCC 1.9828 1.9911 0.42470Major joint replacement or reattachment of lower extremity w/o

MCC 2.0866 2.09530.42

291Heart failure & shock w MCC 1.501 1.5174 1.09190Chronic obstructive pulmonary disease w MCC 1.1684 1.186 1.51312Syncope & collapse 0.7139 0.7339 2.8313Chest pain 0.5434 0.5617 3.36

HFMA Resources

HFMA provides additional information on the following:

IIPS Final Rule:HFMA’s Medicare’s Final Inpatient Payment Rule for FY13 WebinarLarry Goldberg provides commentary on the 2013 final Medicare rule.

Value-Based Purchasing:Hospital Inpatient Value-Based Purchasing Program Fact SheetDiscusses the value-based purchasing program, including scoring methodologies, thresholds, benchmark targets, and measures.

Hospital Readmissions:Hospital Readmissions Reduction Program OverviewProvides a summary of the various aspects of the Hospital Readmissions Reduction Program.

Links to HFMA Resources Addressing IPPS-Related Challenges

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Chad MulvanyTechnical Director

HFMA

1825 K Street, NWSuite 900

Washington, D.C. 20006

Office: 202.238-3453Email:

dmulvany@hfma.org

QUESTIONS

For questions regarding this presentation or the final IPPS Rule, please contact:

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Appendices

Appendix I: Final IPPS Base Rates/Standard Operating Amounts

Appendix II: Standard Federal Capital Rates Appendix III: FY15 Hospital IQR Quality

Measures Appendix IV: FY14 VBP Measures Appendix V: FY15 VBP Measures Appendix VI: FY15 Data Collection Period Appendix VII: FY15 Performance Standards Appendix VIII: Resident Cap Ranking Criteria

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Appendix I: Final IPPS Base Rates/Standard Operating Amounts

National Adjusted Operating Standardized Amounts (68.8 Percent Labor Share/31.2 Percent Nonlabor if Wage Index Is Greater Than 1)

National Adjusted Operating Standardized Amounts(62 Percent Labor Share/38 Percent Nonlabor Share

if Wage Index Is Less Than or Equal To 1)

Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

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Appendix 2: Final IPPS Base RateStandard Federal Capital Rate

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Appendix 3: FY15 Hospital IQR Quality Measures

Topic Hospital IQR Program Measures for FY15 Payment Determination and Subsequent Years

Acute Myocardial Infarction (AMI) Measures AMI-2 Aspirin prescribed at discharge

AMI-7a Fibrinolytic (thrombolytic) agent received within 30 minutes of hospital arrival

AMI-8a Timing of Receipt of Primary Percutaneous Coronary Intervention (PCI)

AMI-10 Statin Prescribed at Discharge

Heart Failure (HF) Measures HF-1 Discharge instructions

HF-2 Evaluation of left ventricular systolic function

HF-3 Angiotensin Converting Enzyme Inhibitor (ACE-I) or Angiotensin II Receptor Blocker (ARB) for left ventricular systolic dysfunction

Stroke (STK) Measure Set STK-1VTE prophylaxis

STK-2 Antithrombotic therapy for ischemic stroke

STK-3 Anticoagulation therapy for Afib/flutter

STK-4 Thrombolytic therapy for acute ischemic stroke

STK-5 Antithrombotic therapy by the end of hospital day 2

STK-6 Discharged on Statin

STK-8 Stroke education

STK-10 Assessed for rehab

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Appendix 3 (continued): FY15 Hospital IQR Quality Measures

Topic Hospital IQR Program Measures for FY15 Payment Determination and Subsequent Years

VTE Measure Set VTE-1 VTE prophylaxis VTE-2 ICU VTE prophylaxis VTE-3 VTE patients with anticoagulation overlap

therapy VTE-4 Patients receiving un-fractionated Heparin with

doses/labs monitored by protocol

VTE-5 VTE discharge instructions VTE-6 Incidence of potentially preventable VTE

Pneumonia (PN) Measures PN-3b Blood culture performed in the emergency

department prior to first antibiotic received in hospital

PN-6 Appropriate initial antibiotic selectionSurgical Care Improvement Project (SCIP) Measures

SCIP INF-1 Prophylactic antibiotic received within 1 hour prior to surgical incision

SCIP INF-2: Prophylactic antibiotic selection for surgical patients

SCIP INF-3 Prophylactic antibiotics discontinued within 24 hours after surgery end time (48 hours for cardiac surgery)

SCIP INF-4: Cardiac surgery patients with controlled 6AM postoperative serum glucose

SCIP INF-9: Postoperative urinary catheter removal on post operative day 1 or 2 with day of surgery being day zero

SCIP INF-10: Surgery patients with perioperative temperature management

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Appendix 3 (continued): FY15 Hospital IQR Quality Measures

Topic Hospital IQR Program Measures for FY15 Payment Determination and Subsequent Years SCIP Cardiovascular-2: Surgery Patients on a Beta Blocker prior to

arrival who received a Beta Blocker during the perioperative period

SCIP-VTE-2: Surgery patients who received appropriate VTE prophylaxis within 24 hours pre/post surgery

Mortality Measures (Medicare Patients) Acute Myocardial Infarction (AMI) 30-day mortality rate Heart Failure (HF) 30-day mortality rate Pneumonia (PN) 30-day mortality rate

Patients' Experience of Care Measures HCAHPS survey (expanded to include one 3-item care transition set*

and two new “About You” items)Readmission Measures (Medicare Patients)

Acute Myocardial Infarction 30-day Risk Standardized Readmission Measure

Heart Failure 30-day Risk Standardized Readmission Measure Pneumonia 30-day Risk Standardized Readmission Measure 30-day Risk Standardized Readmission following Total Hip/Total

Knee Arthroplasty* Hospital-Wide All-Cause Unplanned Readmission (HWR)*

AHRQ Patient Safety Indicators (PSIs) Composite Measures Complication/patient safety for selected indicators (composite)

AHRQ PSI and Nursing Sensitive Care PSI-4 Death among surgical inpatients with serious treatable complicationsStructural Measures

Participation in a Systematic Database for Cardiac Surgery Participation in a Systematic Clinical Database Registry for Stroke

Care Participation in a Systematic Clinical Database Registry for Nursing

Sensitive Care Participation in a Systematic Clinical Database Registry for General

Surgery

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Appendix 3 (continued): FY15 Hospital IQR Quality Measures

Topic Hospital IQR Program Measures for FY15 Payment Determination and Subsequent Years

Healthcare-Associated Infections Measures Central Line Associated Bloodstream Infection

Surgical Site Infection

Catheter-Associated Urinary Tract Infection

MRSA Bacteremia

Clostridium Difficile (C.Diff)

Healthcare Personnel Influenza Vaccination

Surgical Complications Hip/Knee Complication: Hospital-level Risk-StandardizedComplication Rate (RSCR) following Elective Primary Total Hip Arthroplasty

Emergency Department (ED)Throughput Measures ED-1 Median time from emergency department arrival to time of

departure from the emergency room for patients admitted to the hospital

ED-2 Median time from admit decision to time of departure from the emergency department for emergency department patients admitted to the inpatient status

Prevention: Global Immunization (IMM) Measures Immunization for Influenza

Immunization for Pneumonia

Cost Efficiency Medicare Spending per Beneficiary

Perinatal CareElective delivery prior to 39 completed weeks of gestation

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Appendix 4: FY14 VBP Measures

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Appendix 5: FY15 VBP Measures

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Appendix 6: FY15 Data Collection Period

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Appendix 7: FY15 Performance Standards

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Appendix 8: Resident Cap Ranking Criteria

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Appendix 8 (continued): Resident Cap Ranking Criteria

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