The Proposed Rule reflects the increasing focus on quality, which will continue to be an issue for providers, not only for payment purposes, but also for compliance and enforcement.

Pursuant to DRA § 5001(a)(2), hospitals that do not participate in the RHQDAPU program or do not comply with the program’s reporting requirements will have their annual payment update reduced by 2.0 percentage points for that fiscal year. For the FY 2010 payment determination, CMS added 15 new measures to the RHQDAPU program and retired two measures: beta blocker at arrival for heart attack care and pneumonia oxygenation assessment. The deadline for submitting a request for reconsideration in connection with the FY 2010 payment determination is November 1, 2009, and CMS proposes that all hospitals submit a request for reconsideration regarding the fulfillment of RHQDAPU program requirements and receive a decision on that request before filing an appeal with the PRRB. CMS is soliciting public comments on the extent to which the proposed procedures will be less costly for hospitals, and whether they will lead to fewer PRRB appeals.

The proposed RHQDAPU program quality measures for FY 2011 include two new chart-abstracted measures and two new structural measures: (1) postoperative urinary catheter removal on postoperative day one or two, (2) perioperative temperature management, (3) participation in a systematic clinical database registry for stroke care, and (4) participation in a systematic clinical database registry for nursing sensitive care. The two surgical measures are endorsed by the National Quality Forum. CMS also proposes a harmonization of two measures—death among surgical patients with treatable serious complications and nursing sensitive failure to rescue—into the single name “death among surgical inpatients with serious, treatable complications.”

Additionally, for FY 2011 and subsequent years, hospitals would be required to electronically acknowledge on an annual basis the completeness and accuracy of the data submitted for the RHQDAPU program payment determination under the Proposed Rule.

CMS is seeking comments on the proposed new quality measures and on a number of RHQDAPU program issues including: (1) identifying measures that may be suitable for retirement; (2) suggestions on how all-payer claims data can be collected and used by CMS to calculate measures; (3) recommendations on additional Agency for Healthcare Research and Quality (AHRQ) measures that CMS should consider adopting for future RHQDAPU program payment determinations; (4) comments on registry structural measures; and (5) comments about rules CMS could adopt to enable hospitals to request either an extension or a waiver of various RHQDAPU program requirements in the event of a disaster.