Your Guide Through The Labyrinth Of Legislation

See the Change before it Changes You

By now you see that Direct Difference is a fully-integrated company that provides the full range of project-management services. In one of those roles, we provide industry-leading guidance in the legislation and regulatory changes that may affect the delivery of health care services and patient outcomes.

In this role, we are interpreters offering guidance and advice on policy and legislation. We are not auditors. We’re not lobbyists. And we do not have a priori access to legislators and other public policy makers.

Gain a deeper understanding.

We have dedicated ourselves exclusively to the service of health care organizations. As such, we have developed a deep understanding of the legal and regulatory processes and fiscal constraints that often dictate your organization’s ability to meet the needs of the populations you serve.

We have helped hundreds of health care organizations to maximize their resources, make better management decisions using performance measurement techniques. But we have also worked to improve business processes by sharpening the organization’s ability to respond to federal and state compliance, and improve overall patient outcomes.
Many of our consultants and staff professionals have extensive experience and subject matter knowledge in a range of government-related topics, including CMS, but also the Joint Commission.

Ensure compliance with rapidly-changing healthcare legislation.

Direct Difference will continually update and give guidance to your healthcare organization regarding current and future legislation regarding core measures.  Our consulting team is innovative and we put strategies into place for sustainable performance improvement.  To reach great success it requires perspective and perseverance. As leaders in healthcare consulting this strategy and transformation brings you valuable guidance every step of the way, from strategy development through to execution.

Ask Direct Difference to guide you through the labyrinth of change.

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This information is provided as a courtesy to our clients and friends.


OVERVIEW:  On July 31, 2009, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises policies and payment rates for general acute care hospitals that are paid for inpatient services under the Inpatient Prospective Payment System (IPPS), effective for discharges in fiscal year 2010 – that is, on or after October 1, 2009.  In addition to promoting accurate payment for inpatient services to Medicare beneficiaries, the final rule strengthens the relationship between payment and quality of service, by expanding the quality measures that hospitals must report in order to receive the full market basket update in fiscal year 2011.  Under the Medicare law, hospitals that choose not to participate in the voluntary reporting program or do not participate successfully will receive an inflation update equal to the hospital market basket less two percentage points The final rule sets the market basket at 2.1 percent, and, therefore, hospitals that do not successfully report the quality measures will receive updates of 0.1 percent.
The final rule does not change the list of hospital-acquired conditions (HACs) in FY 2010, but describes CMS’s plans to evaluate the impact of the existing policy on hospital practices and patient care.

This Fact Sheet discusses only the quality provisions of the IPPS FY 2010 final rule; separate fact sheets also issued today provide more detail on the payment and policy changes.

BACKGROUND: The Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) and HACs initiatives represent significant steps toward implementing value-based purchasing (VBP) in Medicare.   VBP is intended to transform Medicare from a passive payer for services to a prudent purchaser of services, paying not just for quantity of services but for quality as well.

The RHQDAPU initiative grew out of the Hospital Quality Initiative developed by CMS in consultation with hospital groups.  Participation in the program is voluntary, but after initial levels of participation proved disappointing, Congress added a financial incentive to the program in the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003.

Under the MMA, hospitals that chose not to participate or failed to meet the criteria for successful reporting in a given year received the annual payment update reduced by 0.4 percentage points.  The Deficit Reduction Act of 2005 increased this reduction to 2.0 percentage points.  Since the implementation of the financial incentive, hospital participation has increased to 99 percent and, of participating hospitals, 97 percent receive the full annual payment update in FY 2009.