Maximize impact: Leverage CDI and coding teams on publicly available quality metrics

July 5, 2023

The Hospital Inpatient Quality Reporting Program was initially mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. CMS was mandated to reimburse hospitals that were accurately reporting designated quality measures a higher annual update to their payment rates under the program. 

Purpose revealed  

CMS collects quality data from hospitals paid under the IPPS. Its goal is to improve quality and help consumers make more informed decisions about their health care through measurement and transparency by publicly displaying data. 

Through the program, CMS intends to encourage hospitals and clinicians to improve the quality and decrease the cost of inpatient care provided to all patients. The data collected through the program is available to consumers and providers on the Hospital Compare website.

Data for selected measures is also used for paying a portion of the hospital’s reimbursement based on the quality and efficiency of care, via the Hospital Value-Based Purchasing Program, Hospital-Acquired Condition Reduction Program, and Hospital Readmissions Reduction Program. 

Complication challenges 

In the MS-DRG system, many MS-DRGs require a secondary diagnosis that is classified as a complication/comorbidity (CC) or major complication/comorbidity (MCC). The Medicare definition of complication is, “any condition that occurred after admission.” 

For more on quality metrics, read the full article in JustCoding. 

Amanda Vincent, Javier Ortiz, and Teresa Brown, RN, CCDS, CDIP, CCS