Payment Impacts in Wound Care: Medicare Quality Measures for Hospitals Protection Status
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by Glenda Motta RN, MPH

Centers for Medicare and Medicaid Services (CMS) just released regulations for acute and long-term care hospitals that include a new set of quality measures that will determine payment starting in the fiscal year 2015. The initial set of 10 quality measures was put in place in 2004 as mandated by the Medicare Prescription Drug, Improvement and Modernization Act (MMA).

When the measures were first implemented, participation was voluntary but hospitals that chose not to participate or that failed to meet the criteria for successful reporting of quality indicators received a 0.4 percent reduction to the applicable percentage payment increase for that fiscal year. The Deficit Reduction Act of 2005 increased this percentage reduction to 2.0 percent and, as a result, hospital participation has increased to 99 percent as of fiscal year 2011.

In the new regulations, the initial set of 10 quality measures has grown to 76 measures which include:

  • Chart-abstracted measures for heart attack, heart failure, stroke, venous thromboembolism, pneumonia, surgical care improvement, emergency department throughput, and global immunization
  • Healthcare-associated infection measures for central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), catheter-associated urinary tract infection (CAUTI), MRSA bacteremia, C. Difficile, and influenza vaccination coverage among healthcare personnel
  • Claims-based measures for mortality and readmissions for heart attack, heart failure, and pneumonia
  • Claims-based measures of Hospital Acquired Conditions (HACs)
  • AHRQ Patient Safety Indicators and Inpatient Quality Indicators
  • Nursing sensitive care measure
  • An efficiency measure for Medicare spending per beneficiary
  • A survey-based measure of patient satisfaction

Long-term care hospitals (LTCHs) quality reporting program was also expanded. Specifically, CMS will collect data from October 1 through December 31, 2012 for the LTCH’s fiscal year 2014 payment determination on the following quality measures that focus on patient safety:

  • Catheter Associated Urinary Tract Infection (CAUTI)
  • Central Line Associated Blood Stream Infection (CLABSI)
  • Pressure Ulcers that are New or Have Worsened. This is the percentage of patients who have one or more stage II-IV pressure ulcers that are new or worsened from a previous assessment

Bottom line: it appears that wound care clinicians should be more valuable than ever to both acute and long-term care hospitals. These facilities will also be evaluating new technologies that will help meet the quality mandates so that payment is not impacted.

About The Author
Glenda Motta RN, MPH is a reimbursement consultant and wound care expert, publishing over 125 articles and books, serving as the President of the WOCN (1987-1989), and founding GM Associates, Inc., a healthcare marketing and reimbursement firm.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of [publication name], Kestrel Health Information, Inc., its affiliates, or subsidiary companies.



I couldn't agree with you more. Wound care clinicians' value in long term care is more than they are currently credited for. Facilities should have a method in place that promotes documentation, communication, and in many cases, shared responsibility among staff.

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