The Hospital VBP Program is a budget-neutral program funded by reducing participating hospitals base operating MS-DRG payments each fiscal year by 2% and redistributing the entire amount back to the hospitals as value-based incentive payments. This document describes the versions of the standards and code systems used in conjunction with the updated eCQMs for potential use in the Centers for Medicare & Medicaid Services (CMS) programs for the 2023 reporting/performance period. This includes three technologies submitted under the traditional new technology add-on payment pathway and five technologies submitted under the alternative pathway for new medical devices that are part of the FDA Breakthrough Devices Program. The CMS Measure Inventory Tool (CMIT) is the repository of record for information about the measures which CMS uses to promote healthcare quality and quality improvement. The Centers for Medicare & Medicaid Services (CMS) has finalized the removal of two eCQMs for the 2023 performance period for Eligible Clinicians in the Merit-based Incentive Payment System (MIPS) program: CMS66v11: Functional Status Assessment for Total Knee Replacement and CMS134v11: Diabetes: Medical Attention for Nephropathy. PDF Quality ID #134: Preventive Care and Screening: Screening for for Measure #2, Measure #3 and Measure #5.3 These specifications are designed for reporting by provider organizations. The follow-up Hospital Readmissions Reduction Program (HRRP). Revisions to the potential future definition of digital quality measures; Data standardization activities to leverage and advance standards for digital data; and. The Centers for Medicare & Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications for the 2023 reporting/performance period for: Eligible Hospitals (EH) and Critical Access Hospitals (CAHs), Hospital Hybrid, Outpatient Quality Reporting (OQR), and Eligible Clinician programs. We believe using the charge inflation factors and CCR adjustment factors derived from these data provide a more reasonable approximation of the increase in costs that will occur from FY 2021 to FY 2023, because we do not believe the charge inflation that has occurred during the PHE will continue as the number of higher cost COVID-19 cases declines. FY 2023 Hospital Inpatient Prospective Payment System (IPPS) and - CMS In this final rule, we return to our historical practice of using the most recent available data, including the FY 2021 MedPAR claims and the FY 2020 cost reports, for the FY 2023 rate setting, with certain modifications to our usual rate setting methodologies to account for the anticipated decline in COVID-19 hospitalizations of Medicare beneficiaries at IPPS hospitals and LTCHs, as compared to FY 2021. the current COVID-19 PHE, to continue COVID-19 and seasonal influenza reporting. Make mandatory the Electronic Prescribing Objectives Query of Prescription Drug Monitoring Program (PDMP) measure, adding a third exclusion to the two that we proposed; expand the measure to include not only Schedule II opioids, but also Schedule III and IV drugs, and maintain the associated points at 10 points; Add a new Enabling Exchange under the Trusted Exchange Framework and Common Agreement (TEFCA) measure under the Health Information Exchange (HIE) Objective as a yes/no attestation measure, beginning with the EHR reporting period in CY 2023, as an optional alternative to the three existing measures under the HIE Objective; Add a new Antimicrobial Use and Resistance (AUR) Surveillance measure and require its reporting under the Public Health and Clinical Data Exchange Objective, beginning with the CY 2024 EHR reporting period; Beginning with the CY 2023 EHR reporting period, reduce the active engagement options for the Public Health and Clinical Data Exchange Objective from three to two options; Beginning with the CY 2023 EHR reporting period, require submission of the level of active engagement, in addition to submitting the measures for the Public Health and Clinical Data Exchange Objective; Beginning with the CY 2024 EHR reporting period, require eligible hospitals and CAHs to limit the duration of their time on level of active engagement option one to a single EHR reporting period. These policies are intended to ensure that these programs do not reward or penalize hospitals based on circumstances caused by the PHE for COVID-19 that the measures were not designed to accommodate. *Note: There is a known issue on CMS127v11. 10 Things You Need to Know About CMS's New eCQM Requirements - Innovaccer Additionally, due to the impact of the COVID-19 public health emergency (PHE) on measure data, we are pausing the use of several measures in the scoring of the Hospital VBP and HAC Reduction Programs. Updated eCQM Specifications and eCQM Materials for 2022 Reporting Now The Measure Information Section also refers to the codes or tables provided in this section. This update reflects the most recent data available, including a revised outlook regarding the U.S. economy and, as a result, is 1.1 percentage point higher than the proposed update for FY2023. For the FY 2023 HAC Reduction Program, participating hospitals will not be given a measure score, a Total HAC score, nor a payment adjustment. As disparity initiatives expand, it is important to model efforts off of existing best practices. If the number of weighted FTE residents does not exceed that FTE cap, then the allowable weighted FTE count for direct GME payment is the actual weighted FTE count. Published Date. Note that an ONC Project Tracking System (Jira) account is required to ask a question or comment. Applications for NTAP Approved for FY 2023. Consistent with Executive Order 13985 on Advancing Racial Equity and Support for Underserved Communities through the federal government, CMS sought stakeholder feedback on ways to advance health equity in the proposed rule. Clarified that the "Total" rate is used for the Use of Imaging Studies for Low Back Pain (LBP) measure. Each year, CMS makes updates to the eCQMs approved for CMS programs to reflect changes in: Important to the development of eCQMs is the use of value sets. CMS has also finalized the inclusion of one new eCQM for the 2023 performance period: CMS951v1: Kidney Health Evaluation. Rather, CMS is finalizing a policy that calculates the rural floor as it was calculated before FY 2020. ORIGINAL POSTING DATE: October 26, 2022 . Now Available: Updated eCQM Specifications and Implementation Resources View. CMS sought and received comments on: A summary of these comments is provided in the final rule and will be used to inform potential future policy development. The updated eCQM specifications are available on the Electronic Clinical Quality Improvement eCQI Resource Center (eCQI RC) for EH/CAH, EH/CAH Pre-Rulemaking, Hybrid, OQR and Eligible Clinician pages under the 2023 Reporting/Performance Period. The Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin that describes the 2023 and 2024 updates to the Core Set of children's healthcare quality measures for Medicaid and the Children's Health Insurance Program (CHIP) and the Core Set of health care quality measures for adults enrolled in Medicaid (the Adult Core. An official website of the United States government. CMS did not propose any new MS-DRGs for FY 2023, which means the number of MS-DRGs is maintained at 767 for FY 2023. CMS has published Value Set Guidance to help developers in the design and maintenance of value sets, including areas of naming, description, content choice, and harmonization. Since IPPS payments are generally based on the most recently available Medicare claims and cost report data, which tends to have a lag of two to three years, the statute provides temporary additional payments for certain cases with high costs under the New Technology Add-on Payment (NTAP) policy. PCMH Standardized Measurement - NCQA Two perinatal eCQMs Cesarean Birth and Severe Obstetric Complicationsavailable for self-selection beginning with the CY 2023 reporting period/FY 2025 payment determination followed by mandatory reporting beginning with the CY 2024 reporting period/FY 2026 payment determination. For Questions Regarding eCQMs visit the eCQM Issue Tracker. No changes have been made to Value Sets, Direct Reference Codes, or Terminology. Now Available: Revised eCQM Measure Files and Measures Table for 2023 Performance Period for Eligible Clinicians (EC), Eligible Hospital / Critical Access Hospital eCQMs, FHIR - Fast Healthcare Interoperability Resources, QRDA - Quality Reporting Document Architecture, USCDI+ Quality - United States Core Data for Interoperability Plus Quality, ONC Project Tracking System (Jira) account, Now Available: 2024 CMS QRDA III Implementation Guide, Schematron, and Sample Files for Eligible Clinician Programs, Closing Soon: Review and Comment on PQM's Guidebook of Policies and Procedures for PRMR and MSR, 2024 Physician Fee Schedule Proposed Rule Includes Draft Policy Changes for Quality Payment Program, CMS Announces the CY 2024 OPPS Proposed Rule, Save the Date: July 20 CMS Medicare Promoting Interoperability Program 101 Webinar, Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review (PRMR) and Measure Set Review (MSR) Public Comment Period Open Until July 21, The Hospital Quality Reporting System Now Accepting Voluntary Hybrid Measures for the 2024 Reporting Period, New eCQM Annual Update Implementation User Guide, Telehealth Guidance for eCQMs for Eligible Clinician 2023 Quality Reporting (PDF), eCQM Specifications for Eligible Clinicians (ZIP). CMS is establishing this hospital designation in Fall 2023. The rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2023, as required by the statute. Fiscal Year 2024 Hospice Payment Rate Update Final Rule (CMS-1787-F), Fiscal Year 2024 Inpatient Rehabilitation Facility Prospective Payment System Final Rule (CMS-1781-F), Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule, Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule Medicare Shared Savings Program Proposals, CMS Physician Payment Rule Advances Health Equity. For Measure #1 and Measure #4, eCQM specifications are not available. These eCQMs are determined by CMS and require the use of certified electronic health record technology (CEHRT). See issue EKI-15 on theONC eCQM Known Issues Dashboardfor details. Using The Manual TJC (v2024A) You must collect measure data for the 12-month performance period (January 1 - December 31, 2023). This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. Calendar Year (CY) 2023 Reporting Period For the CY 2023 reporting period, hospitals participating in the Hospital Inpatient Quality (IQR) Program are required to report electronic clinical quality measure (eCQM) data, per the FY 2023 IPPS/LTCH PPS Final Rule. For example, for FY2024 we expect to use, audited data on uncompensated care costs from FY 2018, FY2019, and FY 2020 cost reports to determine eligible hospitals uncompensated care payments, Based on the district courts decision in. v. Becerra, we are finalizing a modified policy to be applied prospectively for all teaching hospitals, as well as retrospectively for certain providers and cost years. PDF 2023 ORYX Reporting Requirements - The Joint Commission A summary of these comments is provided in the final rule and will be used to inform potential future policy development. https:// As a result, we are discontinuing new technology add-on payments for these technologies in FY 2023, and we are also discontinuing new technology add-on payments for the technologies that received a one-year extension in FY 2022. CMS is revising the hospital and CAH infection prevention and control CoP requirements that require hospitals and CAHs, after the. CMS sought stakeholder feedback on ways to advance health equity in the proposed rule. The modified policy addresses situations for applying the FTE cap when a hospitals weighted FTE count is greater than its FTE cap, but would not reduce the weighting factor of residents that are beyond their initial residency period to an amount less than 0.5. Under current law, additional payments for Medicare-Dependent Hospitals (MDHs) and the temporary change in payments for low volume hospitals are set to expire in FY2023. Find older eCQM specifications in the eCQM Standards and Tools Version table. Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 . CMS also solicited and received comment on potential names for the designation and additional potential data sources for CMS to consider in the future for purposes of awarding this designation. While we are not responding to comments in the final rule, we will continue to take all concerns, comments, and suggestions into consideration as we continue work to address and develop policies on these important topics. The amount of data that you must submit ('data completeness') depends on the collection type of the measure. The Blueprint content contains important information regarding the evaluation of Our current regulations do not allow GME affiliation agreements for RTPs. PDF FY 2024 IPPS/LTCH PPS Proposed Rule Overview for Hospital Quality Lastly, CMS is establishing submission and reporting requirements for Patient-Reported Outcome measures beginning with the FY 2026 payment determination, specifically for the THA/TKA Patient-Reported Outcome measure being finalized in this final rule, since this is a new measure type for the Hospital IQR Program. Medicare Promoting Interoperability Program. These revisions require hospitals and CAHs, after the conclusion of the current COVID-19 PHE, to continue COVID-19 and seasonal influenza reporting. In the past, these payments have been extended by legislation, but if they were to expire, CMS estimates that payments to these hospitals would decrease by $0.6 billion. To successfully participate in the Medicare and Medicaid Promoting Interoperability Programs, CMS requires EPs, eligible hospitals, CAHs, and dual-eligible hospitals to report on eCQMs. We are finalizing two proposed changes to our GME policies. The updated eCQMs are to be used by eligible clinicians to electronically report 2023 clinical quality measure data for CMS quality reporting programs. the current COVID-19 PHE, to continue reporting on a reduced number of COVID-19 data elements. Pausing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and five Hospital Acquired Infection (HAI) measures, for the purposes of scoring and payment for the FY 2023 program year. Our current regulations do not allow GME affiliation agreements for RTPs. CMS Measures Management System (MMS) Hub. CMS goal is to use the best available data overall when setting inpatient hospital payment rates for the upcoming fiscal year. CMS also requested comment on the potential future adoption of two Centers for Disease Control and Preventions National Healthcare Safety Network (NHSN) measures. In this final rule, CMS will distribute roughly $6.8billion in uncompensated care payments for FY 2023, a decrease of approximately $318 million from FY 2022. PDF 2023 Health Plan Ratings Required HEDIS , CAHPS and HOS Measures Thus, we will use this input for future development and expansion of policies to advance health equity across the LTCH QRP, including by supporting LTCHs in their efforts to ensure equity for all of their patients, and to identify opportunities for improvements in health outcomes. Electronic Clinical Quality Measures (eCQMs) March 2023 Page 3 eCQM developers need to be knowledgeable of several tools and resources: The Blueprint content - The Blueprint is part of the . beginning with the FY 2024 program year (confidential hospital feedback reports for this measure will include this modification for the FY 2023 program year; paused from being used for payment calculation, CMS will still be calculating and publicly reporting this measure. These measure specifications were previously posted to the EC eCQMs page on the eCQI Resource Center. *Note: There is a known issue on CMS156v11. Under these two payment systems, CMS sets base payment rates prospectively for inpatient stays based on the patients diagnoses and any services performed. The eCQM Data Element Repository, a resource that provides all the data elements associated with eCQMs in CMS quality reporting programs, will be updated after the measure publication to reflect data element updates to improve clarity for eCQM implementation. CMS will continue to engage with stakeholders regarding this issue and reassess for future rulemaking. For Questions Regarding eCQMs visit the eCQM Issue Tracker. In this final rule, CMS is: As a result of the above measure pauses for the FY 2023 program year, less than half of the Hospital VBP Program measures will be available for accurate scoring. Theme 1: MSSP ACOs must start reporting using eCQMs or CQMs. 2023 Program Requirements In the fall of 2022, CMS finalized changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals (CAHs) for calendar year (CY) 2023. Hospital-Level Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Patient-Reported Outcome performance measure beginning with two voluntary reporting periods (July 1, 2023 through June 30, 2024 and July 1, 2024 through June 30, 2025), followed by mandatory reporting for the reporting period which runs from July 1, 2025 through June 30, 2026, impacting the FY 2028 payment determination. CMS requires the use of the most current version of the eCQMs as specified and intended for the applicable performance periods for all quality reporting programs. CMS distributes a prospectively determined amount of uncompensated care payments to Medicare DSHs based on their relative share of uncompensated care nationally. These revisions. *2021 - 2024 Only: ACOs could choose to continue reporting Quality measures via the CMS Web Interface. This document describes the versions of the standards and code systems used in conjunction with the updated eCQMs for potential use in the Centers for Medicare & Medicaid Services (CMS) programs for the 2024 reporting/performance period. CMS will also calculate measure rates for all measures and publicly report those rates where feasible and appropriately caveated. CMS notes in the final rule that it received comments on key considerations in five specific areas that could inform our approach: identification of goals and approaches for measuring health care disparities and using measure stratification across CMS quality programs; guiding principles for selecting and prioritizing measures for disparity reporting across CMS quality programs; principles for social risk factor and demographic data selection and use; identification of meaningful performance differences; and guiding principles for reporting disparity results. This proposal was made in conjunction with Vice President Harris nationwide call to action to reduce maternal mortality and morbidity, which included CMS intention to establish this proposed hospital designation. For the FY 2023 HAC Reduction Program, participating hospitals will not be given a measure score, a Total HAC score, nor a payment adjustment. In addition, CMS projects Medicare disproportionate share hospital (DSH) payments and Medicare uncompensated care payments combined will decrease in FY 2023 by approximately $0.3 billion. Based on the district courts decision in Citrus HMA, LLC, d/b/a Seven Rivers Regional Medical Center v. Becerra, No. Principles for Measuring Health Care Quality Disparities. That means by 2025, everyone is reporting Quality measures as either eCQMs or CQMs The 2023 reporting period eCQM value sets are available through the National Library of Medicines Value Set Authority Center (VSAC). The eCQM Issue Tracker is an online database that allows for the submission and retrieval of questions and answers based on the measure and keyword criterion. For more information, the CMIT User Guide contains details concerning the use of the system. Stakeholders have requested that RTPs be afforded the same flexibility as other teaching hospitals to share their RTP cap slots via special RTP affiliation agreements. CMS has revised the electronic clinical quality measure (eCQM) specification for CMS156v11, Use of High-Risk Medications in Older Adults, for the 2023 reporting/performance period for Eligible Clinician programs. This fact sheet discusses major provisions of the final rule, which can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/current. As finalized, CMS will award this designation to hospitals that report Yes to both questions in the Maternal Morbidity Structural Measure, reporting that the hospital participated in a national or statewide quality collaborative and implemented all recommended interventions. The code tables in this Appendix are evaluated semiannually and modified based on these changes. Continuing to Advance Digital Quality Measurement. In 2016, it became mandatory for eligible hospitals to report data via eCQM for the Hospital Inpatient Quality Reporting Program and the Medicare Promoting Interoperability Program. The eCQI RC includes information about a CMS OQR eCQM; a quality measure that is developed for use in the CMS Outpatient Quality Reporting program. This rule also includes changes to graduate medical education (GME) policies, including increasing flexibility to rural hospitals that. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Electronic Clinical Quality Measures Basics. Second, we are modifying the eCQM reporting and submission requirements to increase eCQM reporting from four eCQMs (one mandatory and three self-selected) to six eCQMs (three mandatory and three self-selected) beginning with the CY 2024 reporting period/FY 2026 payment determination. July 14, 2023, Posting After reviewing the MY 2022 data, the Pharmacotherapy for Opioid Use Disorder (POD) measure was removed from 2023 HPR scoring for the Medicare product line due to insufficient data. CMS eCQM and Hybrid Measure Value Sets eCQMs use data from electronic health records (EHR) and/or health information technology systems to measure health care quality. 6 May 2023 CMS eCQM ID NQF # Measure Title Measure Description Numerator Statement Denominator Statement Measure Set Identifier CMS871v3 3533e Hospital Harm - Severe Hyperglycemia This measure assesses the number of inpatient hospital days for patients age 18 and older with a hyperglycemic event (harm) per the total qualifying inpatient Modifying all six condition/procedure specific readmissions measures to include a risk adjustment for history of COVID-19 within 12 months prior to the index admission, beginning with the FY 2024 program year; Additionally, CMS sought and received public comment on promoting health equity through possible future incorporation of hospital performance for socially at-risk populations into the Hospital Readmissions Reduction Program, which, will be used to inform future policy development. To report eCQMs successfully, health care providers must adhere to the requirements identified by the CMS quality program in which they intend to participate. In total, 25 technologies are eligible to receive add-on payments for FY 2023. To provide flexibility to teaching hospitals that cross-train residents, CMS allows teaching hospitals to enter into Medicare GME affiliation agreements to share and redistribute those cap slots to accommodate the actual rotations of their residents. Ref: QSO-23-02-ALL . TO: State Survey Agency . In addition, theTelehealth Guidance for eCQMs for Eligible Clinician 2023 Quality Reporting document is posted with the Eligible Clinician Table of eCQMs regarding the allowance of telehealth encounters for Eligible ClinicianeCQMs. Screening for Social Drivers of Health measure and Screen Positive Rate for Social Drivers of Health measure beginning with voluntary reporting in the CY 2023 reporting period and mandatory reporting beginning with the CY 2024 reporting period/FY 2026 payment determination. Beginning in FY 2023, CMS is discontinuing the use of low-income insured days as a proxy for uncompensated care in determining the amount of uncompensated care payments for IHS and Tribal hospitals, and hospitals located in Puerto Rico. Get Started with eCQMs eCQM Lifecycle MEASURE COLLABORATION Measure Collaboration (MC) Workspace eCQM Data Element Repository . Treatment of Medicaid Section 1115 Demonstrations for Purposes of Medicare Disproportionate Share Hospital (DSH) Payments. CMS requested comment on the potential future inclusion of two digital NHSN measures: Healthcare-Associated.
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