Select the search type
  • Site
  • Web

Revised Quality Measure Guidance; CBIZ Can Assist

CMS recently revised its quality outcomes methodology. CBIZ is here to assist.

By Rick Parker, Executive Director

May 2022

CBIZ KA Consulting’s Quality Subscription Report services provide cutting-edge solutions to our clients. The goal of our report service is to help improve patient quality outcomes, leading to better patient care and revenue enhancement.

Before we dive into our solutions, let’s first take a look at how the pandemic has altered the CMS quality data. The COVID-19 Public Health Emergency has led to irregularities in the data that is used for quality measurement.  The first wave of Interim Final Rules at the start of the pandemic granted all providers an Extenuating Circumstances Exception (ECE) that exempted providers from reporting Q1 and Q2 2020 data.  For the most part, Medicare will continue to roll single and multi-year performance periods forward by one year, with the exception of the Q1 and Q2 2020 periods.  The exception would be the Hospital-Acquired Condition Penalty where CMS has decided to exclude the entire 2020 period from scoring.  The bottom line is that Medicare has continued to collect quality data after the initial pandemic surge and will be calculating scores and adjustments to reimbursement in future years. Therefore, it is imperative to be proactive to effect positive change in these scores.

By leveraging the CMS data supplied to the hospital, CBIZ provides solutions for many of the quality areas that result in provider penalties. From readmissions rates to Value Based Purchasing to HAC (Hospital-Acquired Condition) scores, CBIZ has identified methods to improve performance in these areas.

Specifically, CBIZ identifies key clinical conditions that trigger the events leading to adverse scores. By completing a risk assessment of all underlying conditions at the patient level, we are able to pinpoint specific remedies that can improve hospital performance in key quality measures.

For example, what is driving a COPD Readmission penalty and what can be done to reduce readmissions? Remember, in most cases just by making a difference in a couple of readmissions, hospitals can significantly reduce readmissions, thereby creating a better patient experience while optimizing revenue.

The Value Based Purchasing (VBP) incentive payment program covers many data elements. One of the main elements is the Medicare Spending per Beneficiary (MSPB).This data covers the Medicare spending related to inpatient episodes at a given hospital. Total spend covers the three days prior to admission, the admission spend and spending 30 days post-discharge.

CBIZ performs a deep dive into the data to determine where and why excess spending exists down to the episode level of care. We also complete a comparison to state and national statistics to better pinpoint by MDCs, HCC codes and age cohorts in an effort to narrow the areas of excess spending. This enables a hospital to target specific types of services. Our data is further broken down into provider types to analyze where the excess is in the Medicare spending. For example is it in the pre-admission, admission or post discharge period and is the excess in the hospital, physician office, home health, and/or skilled nursing facility setting?

CBIZ can also assist hospital in analyzing their Hospital-Acquired Conditions penalties and other VPB statistics in the Clinical Care Domain, Patient Experience of Care, and Safety Measures depending on results and availability of data. Although is important to understand that Medicare uses a three-year trending formula and it does take time to move the needle, our proven quality reporting services have often generated over a 15-1 return on investment for our clients.

To order your CBIZ Quality Subscription Reporting, call me at 609-306-0878 or email me at [email protected].

Copyright © 2022, CBIZ, Inc. All rights reserved. Contents of this publication may not be reproduced without the expressed written consent of CBIZ.