Medicare Quality Rehabilitation

Inpatient Rehabilitation Facility’s Quality Reporting Program

Medicare’s push to evaluate all types of providers is being extended to Inpatient Rehabilitation Hospitals (IRFs).  According to Health Reform bill (specifically, Section 3004 of the Affordable Care Act), CMS is required to start publishing quality measures for IRFs by October 1, 2012. This newly created IRF Quality Reporting Program (QRP) currently has proposed two measures.  These include the following:

  • Presentation of Urinary Catheter-Associated Urinary Tract Infections (CAUTI)
  • Presentation of Percent of Residents with Pressure Ulcers that Are New or Have Worsened

CMS will hold an Open Door Forum on Tuesday, November 29, 2011, 2pm-4pm ET to discuss these measures.  It is disappointing that CMS only has two quality measures for the IRF program.  Thus, the QRP is far less comprehensive then Health Reform intendend.  Hopefully, the number of quality measures increases over time.  The Healthcare Economist does realize, however, that rehabilitation services are much harder to evaluate than more procedure based services with more observable outcomes.  Specifically, improvement in patient functioning is a key measure for IRFs.  However, if the IRFs themselves self-report this data, the quality measures will not be unbiased.  I am assuming that the data for the IRF QRP come from the IRF Patient Assessment Instrument (PAI), and thus the quality data will be self-reported by the IRFs themselves.  Here is the form used by IRFs as part of the PAI.

One problem with any quality system is cases where the provider fails to report the quality data.  In the QRP, however, IRFs will have a strong financial incentive to report these measures.  Specifically, if an IRF fails to report their quality measures, Medicare will reduce their payments by 2 percentage points.


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