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April 25, 2024
2025 IPPS Proposed Rule: Quality Programs for Hospitals

2025 IPPS Proposed Rule: Quality Programs for Hospitals

Last week, we brought you a summation of the key provisions in the Medicare Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year (FY) 2025. Today’s article will focus on the quality programs that concern the inpatient setting. Hospitals that do not submit quality data or do not meet all Hospital Inpatient Quality Reporting (IQR) Program requirements are subject to a one-fourth reduction in their Annual Payment Update (APU) under IPPS.

2025 IPPS Proposed Rule: Quality Programs for Hospitals

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New Measures

In the 2025 IPPS proposed rule, CMS is proposing to adopt seven new quality measures. Specifically, CMS is proposing to adopt two new eCQMs, one claims-based measure, two structural measures, and two healthcare-associated infection (HAI) measures:

    • Hospital Harm – Falls with Injury eCQM, with inclusion in the eCQM measure set beginning with the CY 2026 reporting period/FY 2028 payment determination.
    • Hospital Harm – Post-operative Respiratory Failure eCQM, with inclusion in the eCQM measure set beginning with the CY 2026 reporting period/FY 2028 payment determination.
    • Thirty-day Risk-Standardized Death Rate among Surgical Inpatients with Complications (Failure-to-Rescue) claims-based measure beginning with the July 1, 2023 – June 30, 2025 reporting period, which impacts the FY 2027 payment determination.
    • Patient Safety Structural Measure beginning with the CY 2025 reporting period/FY 2027 payment determination.
    • Age Friendly Hospital structural measure beginning with the CY 2025 reporting period/FY 2027 payment determination.
    • Catheter-Associated Urinary Tract Infection Standardized Infection Ratio Stratified for Oncology Locations measure beginning with the CY 2026 reporting period/FY 2028 payment determination.
    • Central Line-Associated Bloodstream Infection Standardized Infection Ratio Stratified for Oncology Locations measure beginning with the CY 2026 reporting period/FY 2028 payment determination.

Modified Measures

CMS is proposing to modify the following measures:

    • Global Malnutrition Composite Score eCQM beginning with the CY 2026 reporting period/FY 2028 payment determination. This modification adds patients ages 18 to 64 to the current cohort of patients 65 years or older.
    • The proposed updates would refine the current HCAHPS Survey measure by adding three new sub-measures, removing one existing sub-measure, and revising one existing sub-measure. The new survey sub-measures would include: “Care Coordination,” “Restfulness of Hospital Environment,” and “Information about Symptoms.” These three new sub-measures would be publicly reported beginning in October 2026. One current sub-sub-measure, “Care Transition,” would be removed from reporting on Hospital Compare in January 2026. Additionally, the current “Responsiveness of Hospital Staff” sub-measure would be altered starting in January 2025, with the “Call Button” questions being removed from the survey and a new “Get Help” question being added.

Deleted Measures

The proposed rule would remove four payment measures:

    • Hospital-level, Risk-Standardized Payment Associated with a 30-Day Episode of Care for Acute Myocardial Infarction (AMI Payment).
    • Hospital-level, Risk-Standardized Payment Associated with a 30-Day Episode of Care for Heart Failure (HF Payment).
    • Hospital-level, Risk-Standardized Payment Associated with a 30-Day Episode of Care for Pneumonia (PN Payment).
    • Hospital-level, Risk-Standardized Payment Associated with a 30-day Episode of Care for Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA Payment).

Promoting Interoperability

The proposed rule contains the following measure-related changes in the Medicare Promoting Interoperability Program for eligible hospitals and CAHs:

    • Separate the Antimicrobial Use and Resistance (AUR) Surveillance measure into two measures, Antimicrobial Use (AU) Surveillance and Antimicrobial Resistance (AR) Surveillance, beginning with the EHR reporting period in CY 2025;
    • Adopt two new eCQMs for eligible hospitals and CAHs to select as one of their three self-selected eCQMs, in alignment with the Hospital IQR Program, beginning with the CY 2026 reporting period.
    • Modify the Global Malnutrition Composite Score eCQM by adding patients ages 18 to 64 to the current cohort of patients 65 years or older.
    • Modify eCQM data reporting and submission requirements in alignment with the Hospital IQR Program by proposing a progressive increase in the number of mandatory eCQMs eligible hospitals and CAHs would be required to report on beginning with the EHR reporting period in CY 2026.

We will have more information concerning other quality/measure related programs in a future article. In the meantime, you can go to the following link for more information on quality programs related to the inpatient hospital setting: FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Proposed Rule - CMS-1808-P Fact Sheet | CMS.