5 ways CMS’ proposed hospital rule could affect patient safety and quality

Through its proposed Hospital Inpatient Prospective Payment System rule, the Centers for Medicare and Medicaid Services is building on administration-level priorities to better assess disparities in healthcare quality and improve patient outcomes.

The recommended rule, released on Monday, discusses potential increases to inpatient hospital payments and cuts to Medicare disproportionate share hospital payments, as well as how certain reporting requirements were affected by the pandemic.

In particular, CMS details how it is encouraging hospitals to adhere to reporting measures and document data in order to benefit communities typically underserved by the healthcare system.

Here are five things to know about the proposed rule’s focus on care quality and safety:

1. Centralized focus on equity. Most aspects of the proposal revolve around hospitals reporting their commitment to addressing social determinants of health and establishing a culture of equity. It is the first concrete proposal to come out of the Biden administration that could affect hospitals’ operations and strategic changes, said Ge Bai, professor of health policy and management at Johns Hopkins Bloomberg School of Public Health.

The proposed rule would enforce screening for patients’ health-related social needs and risk factors; reporting on hospitals’ investments in helping disadvantaged groups access care; addressing contributors to poor health outcomes; and collecting equity-related data. The agency also asked for input on how to measure healthcare quality disparities, what to prioritize in data collection and reporting, and how to drive accountability in providers’ equity efforts.

2. Commitment to improving maternal health. It would create a “birthing-friendly” designation for hospitals that have implemented best practices to advance healthcare quality, safety and equity for pregnant and postpartum patients. According to CMS, hospitals that fulfill the recommended Maternal Morbidity Structural Measure would be viewed as safer and higher-quality facilities for patients seeking maternity care.

Two proposed quality measures for the Hospital Inpatient Quality Reporting program, involving hospitals’ measure of low-risk Cesarean deliveries and severe obstetric complications, are also intended to improve maternal health outcomes.

3. More quality reporting measures. Among a number of new measures, hospitals would be required to submit patient-reported outcome performance measures and complication rates, specifically for hospital-level total hip or knee arthroplasty procedures.

4. Resumed readmission measures. Under a reworked Hospital Readmissions Reduction Program, hospitals would not be penalized based on readmission rates and circumstances caused by the public health emergency. Readmission rates following hospitalizations for pneumonia and other conditions would resume to keep track of health outcomes while excluding COVID-19 diagnosed patients.

CMS seeks advice on how to update its readmission program and encourage providers to improve their performance for socially at-risk populations is a good sign, said Maryellen Guinan, policy manager at America’s Essential Hospitals, an industry trade group located in Washington D.C.

“That’s something we have certainly called for in previous comments, knowing that dual eligibility is a crude proxy for poverty and social risk, so there should be other factors that are included,” Guinan said.

5. Hospital preparation for climate change. CMS seeks comments on how hospitals, nursing homes, hospices, home health agencies and other providers can better prepare for the effects of climate change on operations as well as Medicare beneficiaries and consumers, in line with the 2021 executive order on addressing the climate crisis.

The agency is also asking how it can help hospitals take action on reducing emissions and track their progress.

“Environmental, social and governance [efforts] are not just a nice thing to do anymore,” said Rick Kes, a healthcare industry senior analyst at RSM, an audit, tax, and consulting firm. “You need to do it because a lot of health equity outcome-related data is going to impact your reimbursements.”