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October 10, 2017

MedPAC eyes eliminating 2 hospital quality programs, merging 2 others

Daily Briefing

The Medicare Payment Advisory Commission (MedPAC) on Friday discussed a proposal that would eliminate two hospital quality programs and combine two others in an effort to simplify the reporting process.

The meeting focused on the:

  • Hospital Inpatient Quality Reporting Program (IQR), which rewards hospitals for successfully reporting designated quality measures;
  • Hospital-Acquired Conditions Reduction Program (HACRP), which evaluates hospitals based on infection rates and patient safety and penalizes the worst-performing facilities;
  • Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals that have a higher-than-expected number of readmissions for certain conditions; and
  • Hospital Value-Based Purchasing Program (HVBP), which adjusts hospitals' reimbursement based on their performance on quality and patient experience measures.

MedPAC policy analyst Ledia Tabor during the meeting said, "There are currently too many overlapping programs, which creates unneeded complexity for Medicare and for hospitals," adding, "For simplicity, hospitals should have their payment adjusted under one program as opposed to separate programs."

Proposed changes

During the meeting, commissioners floated asking Congress to do away with CMS' inpatient quality reporting and hospital-acquired conditions programs.

The commissioners also said they are considering urging Congress to combine HRRP and HVBP into a single program, called the Hospital Value Incentive Program, which would evaluate hospitals based on mortality, readmissions, and spending rates as well as patient experience. However, the program would not hold hospitals financially responsible for infections developed by patients while in their care because of concerns that it would discourage hospitals from improving infection detection, commissioners said.

Under the program, CMS would withhold 2 percent of hospitals' Medicare reimbursements. If a hospital performed better than those in its peer group, they would get a bonus larger than what was withheld. If a hospital performed worse than those in its peer group, the hospital would get less than what was withheld. According to Modern Healthcare, peer groups would be created based on the needs of the patients hospitals serve.


During the meeting, some commissioners raised concerns that not including hospital-acquired infections could discourage some hospitals from improving their infection rates. But overall, commissioners said they favored the idea a single hospital quality program.

MedPAC's staff will continue to develop the new hospital quality model before the spring, when they are expected to reintroduce the proposal, Modern Healthcare reports (Dickson, Modern Healthcare, 10/6).

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