Wednesday, November 26, 2014

AHCA Submits Comments Regarding Hip and Knee Replacement Payment Measure that may Impact SNFs

Dan Ciolek


On November 21, AHCA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding a hospital payment outcomes measure being developed for elective total hip and total knee replacements. The proposed hospital measure includes post-acute services furnished within a 90-day window (including skilled nursing facility (SNF) and outpatient therapy services) so there is relevance to SNF providers, and therefore a need for comments on what AHCA perceives as concerns. The CMS documents that AHCA responded to can be found here. A copy of the AHCA comments can be found here.

At the end of the public comment period, all public comments will be posted on the CMS Web site - here.

Background

The Centers for Medicare & Medicaid Services (CMS) contracted with Yale New Haven Health Systems Corporation/Center for Outcomes Research and Evaluation (CORE) to develop a hospital-level measure of risk-standardized, 90-day episode-of-care payments for elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA). The contract name is Development, Reevaluation, and Implementation of Hospital Outcome/Efficiency Measures. As part of its measure development process, CMS requested interested parties to submit comments on the candidate or concept measures that may be suitable for this project.

The purpose of the project is to develop an outcome measure that can be used to support quality improvement. The public comment period provided an opportunity for the widest array of interested parties to provide input on the measure under development. Comments from the public can offer critical suggestions in additions to those identified by the measure contractors and their technical expert panel (TEP).

Project Objectives:

· To develop a hospital-level measure of risk-standardized, 90-day episode-of-care payments for elective primary THA/TKA.

Specific Project Objectives:

The goal of this project is to develop an administrative claims-based, hospital-level, risk-standardized measure for payment associated with a 90-day episode-of-care following an elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA).

The development process includes:

· Identifying importance of outcome

· Conducting a literature review and environmental scan

· Defining and developing specifications for the measure

· Obtaining evaluation of proposed measure by technical expert panel

· Posting measure for public comment

· Testing measure for reliability, validity, and feasibility

· Refining measure, as needed

Details about the measure development process can be found in the Measures Management System Blueprint at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MeasuresManagementSystemBlueprint.html.

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