Federal law requires hospitals to be penalized for excessive hospital readmissions within 30 days of discharge based on selected conditions. Pneumonia and COPD are among the quality measures hospitals must report as part of the Hospital Readmissions Reduction Program. COPD, for example, has been listed as the 4th most costly in terms of readmissions according to the Medicare Payment Advisory Commission. Each year the Medicare program updates the rates as well as the quality measures. Over time, the quality measure for pneumonia has been expanded and future measures added. For example, the principal discharge diagnosis for pneumonia now includes aspiration pneumonia and a principal diagnosis of either sepsis or respiratory failure with a secondary diagnosis of pneumonia present on admission.
In the 2018 update, CMS has added a new quality measure effective for FY 2022 that impacts payment associated with a 30-Day Episode of Care for Pneumonia. The measure was first adopted in FY 2015 and later modified in FY 2017. The new measure will be paired with the 30-day pneumonia mortality measure. The reason for this addition is to create stronger incentives to reduce practice pattern variations and to achieve lower costs and improve care coordination by examining payment and patient outcomes concurrently. It also enables CMS to better capture the complete patient population receiving clinical management/treatment for pneumonia.
At the inception of the program, AARC sent comments to CMS highlighting the significant impact RTs can make in reducing COPD readmissions, noting the collection of AARC’s COPD Best Practices. The AARC feels strongly that the role RTs play in striving to help their hospitals meet these quality measures results in overall improvements in unnecessary readmissions. To that end, a request for CMS to analyze the latest COPD claims data in various settings, including the hospital inpatient setting, to help demonstrate the value of RTs in improving health outcomes has been added to report language accompanying the FY 2018 Labor-HHS Appropriations bill. As background, each year Congress is required to pass appropriations bills to fund the Government which are generally accompanied by a report that directs government agencies to take certain actions and report back to Congress. A report from CMS will go a long way to demonstrating respiratory therapists’ unique skills and expertise. While we have to wait for the Senate to act and the bill to be passed, inclusion of the report language in the House is a direct result of the outstanding work by our PACT representatives as part of AARC’s 2017 Advocacy Day on Capitol Hill.