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From Health Law Daily, March 9, 2015

IPF quality measures need improvement, study says

By Bryant Storm, J.D.

Shortcomings remain in the quality of behavioral health treatment within inpatient psychiatric facilities (IPFs) which may require the addition of new measures to the IPF Quality Reporting (IPFQR) program. A review of the testing of new measures for the IPFQR program, conducted by Mathematica Policy Research and the National Committee for Quality Assurance, for the HHS office of the Assistant Secretary for Planning and Evaluation (ASPE) determined that some additional quality measures could be added to improve IPF screening and patient follow up procedures. However, the ASPE report summarizing the results of the review makes no final decisions about which of the tested measures, if any, will ultimately be included in the IPFQR program (ASPE Report, February 4, 2015).

IPFQR. Section 10322 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) created the IPFQR to assist with behavioral health care quality improvement. Under the program, IPFs are obligated to report their performance on a set of quality measures. Failing to report results in a two percentage point reduction to the update of the IPF’s Medicare standard federal rate for the year. To investigate new approaches for the IPFQR program, CMS and ASPE coordinated to evaluate the potential effectiveness of several measures, including: “four chart-based measures that assess screening for risk of suicide, risk of violence, substance use, and metabolic conditions, and one claims-based measure that assesses whether Medicare beneficiaries receive follow-up care after IPF hospitalization.”

Method. To evaluate potential new measures, the APSE project reviewed the existing IPFQR program measures and consulted the help of consumers, IPFs, IPFQR program vendors, state agencies, and performance measurement experts to help in the development process for new measures. ASPE and CMS then developed measures and pilot tested them. The follow up measure was evaluated against Medicare claims data for over 1,600 IPFs and the four chart-based measures were piloted at six IPFs. Quantitative data was used to examine performance rates and the measures were qualitatively evaluated with focus groups and stakeholder input.

Findings. The screening measure which demonstrated the highest prospects for quality improvement was the metabolic screening measure which would require documentation of the following for all individuals discharged on antipsychotic medications: (1) body mass index (BMI); (2) blood pressure; (3) glucose or hemoglobin A1c (HbA1c); and (4) a full lipid panel. The metabolic screening measure had the highest average performance across the IPFs that tested it. Although the report indicates that the suicide, violence, and substance use screening measures performed well, the report cautioned that they created a risk of standardizing screening processes across IPFs. Additionally, the suicide, violence, and substance abuse measures showed some overlap with current IPF quality measures in a manner that presented a risk of unnecessary burden for IPFs. Although the study determined that a follow-up measure could have substantial impact because IPF 30-day follow-up rates are below 55 percent, the project discovered that a claims based measure would not be feasible because of data availability and human resource constraints.

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