Affordable Care Act
Section 3004
Inpatient Rehabilitation Facility
Quality Reporting Program
Provider Training
Caroline D. Gallaher, R.N., B.S.N, J.D.
CMS, Office of Clinical Standards and Quality
Division of Chronic & Post Acute Care
May 2, 2012
Baltimore, MD
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Welcome
• Thank you for taking the time to attend this
session.
• We have mutual goals:
– Improve the health care services provided to
patients.
– Implement the ACA Section 3004 IRF Quality
Reporting Program properly and with the least
burden possible.
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Purpose & Goals of Training
After this training, participants will be able to:
• Understand the requirements of the IRF Quality Reporting
Program.
• Correctly stage pressure ulcers and accurately code pressure
ulcer data on the IRF-PAI.
• Correctly report CAUTI data to CDC.
• Describe resources available for assistance.
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Overview
of the
ACA Section 3004
Inpatient Rehabilitation Facility
Quality Reporting Program
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Mandates of Section 3004
• Section 3004 of the Patient Protection and
Affordable Care Act (PPACA), was passed on March
23, 2010.
• Requires that IRFs submit quality data to CMS in a
form, manner and time specified by the Secretary.
• IRFs that fail to submit the required quality data will
receive a 2% reduction of the annual update to a
standard Federal rate for discharges for the hospital
during the rate year affected.
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How Quality Measures Are Selected
and Quality Measure Data Used
• Data submitted from IRF providers will be used to
calculate quality measures and assess quality of care
provided by IRFs.
• The Centers for Medicare & Medicaid Services (CMS)
selects the quality measures to be used in the IRF
QRP, after giving significant consideration to input
received from stakeholders and the public.
• Quality measures are published through the MAP
process and finalized though rulemaking.
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Measure Applications Partnership (MAP)
Measure Selection Process
• Created under authority of Sec. 3014 of the Affordable Care
Act.
• The MAP is a public-private partnership convened by the
National Quality Forum (NQF).
• Providing input to the Department of Health and Human
Services (HHS) on selecting performance measures for public
reporting, performance-based payment programs, and other
purposes.
• MAP is designed to facilitate alignment of public- and privatesector uses of performance measures to further the National
Quality Strategy’s (NQS) three-part aim of creating better,
more affordable care and healthier people.
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Measure Applications Partnership (MAP)
Measure Selection Process
Anticipated outcomes from MAP’s work include:
• A more cohesive system of care delivery;
• Better and more information for consumer decision-making;
• Heightened accountability for clinicians and providers;
• Higher value for spending by aligning payment with
performance;
• Reduced data collection and reporting burden through
harmonizing measurement activities across public and private
sectors; and
• Improvement in the consistent provision of evidence-based
care.
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National Strategy for
Quality Improvement In Healthcare
• Selection of measures is based, in part, on the
priorities outlined in the National Strategy for
Quality Improvement in Healthcare (available at:
http://www.healthcare.gov/law/resources/reports/nationalqualitystrategy032011.
pdf)
• Three Broad Aims:
– Better Care
– Healthy People/ Healthy Communities
– Affordable Care
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Priorities of the National Strategy
• Making care safer by reducing harm caused in the delivery of care.
• Ensuring that each person and family are engaged as partners in their
care.
• Promoting effective communication and coordination of care.
• Promoting the most effective prevention and treatment practices for the
leading causes of mortality, starting with cardiovascular disease.
• Working with communities to promote wide use of best practices to
enable healthy living.
• Making quality care more affordable for individuals, families, employers,
and governments by developing and spreading new health care delivery
models.
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IRF QRP Quality Measures
In the FY2012 IRF PPS Rule*, two quality
measures were selected for use in the IRF QRP:
1. New or Worsened Pressure Ulcers
And
2. Catheter-Associated Urinary Tract
Infections (CAUTIs)
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Data Submission
Pressure Ulcer Data:
– New, mandatory pressure ulcer items included on the IRFPAI in the “Quality Indicator Section.”
– Other Quality Indicator items that had been voluntary in
past have been deleted (respiratory status, pain, safety).
– Updated IRF-PAI submission software (jIRVEN) will be
available from CMS to support the 10/01/2012 release.
– Same IRF-PAI submission process will be used.
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Data Submission
(continued)
CAUTI Data:
Submitted online to the CDC’s National Healthcare
Safety Network (NHSN).
IRFs that do not already report data to NHSN will be
required to register as an NHSN user, take mandatory
training, and submit a signed agreement allowing data
to be sent to CMS.
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Changes to the IRF-PAI
• The PUSH tool on the IRF-PAI has been replaced with updated
pressure ulcer items (items 48A through 50D).
• Although an IRF may decide not to submit pressure ulcer data
(items 48A through 50D), failure to complete these items may
result in payment reduction of two percentage points starting
in Fiscal Year 2014.
• Voluntary Quality Indicators have been removed
– Respiratory Status
– Pain
– Safety
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Public Reporting
• No timeline has been established for public
reporting of IRF quality measure data.
• Ultimately, IRF quality measure data will be
publicly reported; but ONLY after each facility
has been given a chance to review its results.
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Resources
Ways to keep up-to-date on IRF QRP issues:
• Join the CMS Listserv:
– http://www.cms.hhs.gov/Outreach-andEducation/Outreach/OpenDoorForums/index.html?redirect=/OpenDo
orForums/01_Overview.asp
• Check the IRF QRP Program Web site frequently:
– http://www.cms.gov/IRF-Quality-Reporting/
• Contact one of the help desks if you have any
questions (see help desk slide).
• Many provider associations provide updates.
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Resources
• The IRF Quality Reporting Program Website:
http://www.cms.gov/IRF-Quality-Reporting/
Includes technical information, an overview of
the program, and links to materials.
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Help Desks
For questions about:
• IRF-PAI data coding or IRF-PAI data submission:
Phone: 1-800-339-9313 or e-mail: help@qtso.com
• CAUTI data or submission, NHSN Registration:
e-mail: NHSN@cdc.gov
• Quality measure calculation , data submission deadlines, the
new pressure ulcer items:
e-mail: IRF.questions@cms.hhs.gov
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