News: AHA urges Congress to improve hospital quality, pay-for-performance programs

The American Hospital Association (AHA) hopes to streamline Medicare quality reporting and payment program measures by focusing on high priority quality issues, incorporating a socioeconomic adjustment to the Hospital Readmissions Reduction Program (HRRP), and reforming the existing Hospital-Acquired Conditions Reduction (HACRP) program, according to a statement submitted to Congress on September 7.

When hospitals began to voluntarily report quality and safety data more than a decade ago, they focused on 10 well-defined and scientifically proven measures of heart attack, heart failure, and pneumonia. Congress then linked the voluntary efforts to Medicare payment incentives, and, since, CMS rapidly expanded the number of measures hospitals are required to report. While most healthcare organizations support quality care transparency, the AHA expressed concern that the dramatic increase in reporting requirements—CMS estimates hospitals will have more than 90 measures by 2019—limits the effectiveness of quality efforts and causes confusion for the public, the statement says.

To address these concerns, the AHA wants CMS to focus on quality measures that drive better outcomes for patients. The AHA conducted its own research and identified 11 areas they believe CMS quality reporting and pay-for-performance efforts should prioritize, including patient safety outcomes, readmission rates, risk adjusted mortality, effective patient transitions, diabetes control, and obesity. The agency says focusing quality efforts on high priority measures will improve national quality goals and better serve patients’ interests.

The agency also called on Congress to evaluate readmission penalties through the HRRP. The AHA has long urged the HRRP to incorporate socioeconomic adjustment to ensure hospitals caring for poorer patients are not disproportionately penalized. In June 2016, a bill passed the House of Representatives establishing beneficiary equity that, if approved, would require CMS to use community data to adjust penalties. Hospitals caring for the poorest patients have been more likely to receive penalties under the HRRP.

The AHA suggested CMS exclude readmissions unrelated to the initial reason for admission from the HRRP. The ACA already requires CMS to exclude unrelated readmissions, though CMS has not fully implemented this policy.

In addition, the AHA urged Congress to change existing pay-for-performance legislation for post-acute care providers. “The HACRP is poorly designed and imposes excessive penalties that unfairly affect hospitals caring for sicker patients,” says the AHA.