Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
The pre-rulemaking process provides the Centers for Medicare & Medicaid Services (CMS) with a vehicle to hear from stakeholders for early consideration of measures.
CMS is issuing this List of Measures Under Consideration (MUC) to comply with the statutory requirement that the Secretary of the Department of Health and Human Services (HHS) make publicly available a list of certain quality and efficiency measures that the Secretary is considering for adoption through rulemaking under Medicare. Among the list of measures CMS is considering are measures that were originally suggested by the public. When organizations, such as physician specialty societies, request that CMS consider measures, CMS evaluates the suggested measures to determine whether CMS would consider them for use in one or more Medicare programs. If CMS determines that it would consider the use of a measure and the pre-rulemaking process applies to the measure, CMS adds it to the MUC List as part of the pre-rulemaking process so the Measure Applications Partnership (MAP) can provide input on the measure. Inclusion of a measure on this list does not obligate CMS to propose to adopt or finalize the adoption of the measure for the identified program. Therefore, this list may include a larger number of measures than the number of measures CMS will decide to propose for adoption through rulemaking.
CMS will continue its goal of aligning measures across programs. Measure alignment includes looking first to existing program measures for use in new programs, as well as looking across programs to see if the measure is used in other CMS programs. Further, CMS programs must balance competing goals of establishing parsimonious measure sets, while including sufficient measures to facilitate multi-specialty provider and supplier participation.
The Social Security Act (the Act) requires that the Secretary of HHS establish a pre-rulemaking process for the selection of certain quality and efficiency measures for use by HHS. The pre-rulemaking process requires that HHS make publicly available, not later than December 1 annually, a list of quality and efficiency measures HHS is considering adopting, through the rulemaking process, for use in certain Medicare quality programs and for use in publicly reporting performance information in any Medicare program.
The pre-rulemaking process includes the following additional steps:
1. Providing the opportunity for multi-stakeholder groups to provide input to HHS not later than February 1 annually on the selection of quality and efficiency measures;
2. Requiring the Secretary to consider the multi-stakeholder groups’ input in selecting quality and efficiency measures;
3. Publishing in the Federal Register the rationale for the use of any quality and efficiency measures that are not endorsed by the entity with a contract under section 1890 of the Act, which is currently the National Quality Forum (NQF) and
4. Assessing the quality and efficiency impact of the use of endorsed measures and making that assessment available to the public at least every three years. (The 2012, 2015, 2018, and 2021 editions of that report and related documents are available at the website of the CMS National Impact Assessment.)
The following programs, which now use or will use quality and efficiency measures, take part in the section 1890A pre-rulemaking process. Not all of these programs have measures on the current MUC List; those shown in boldface have one or more measures on this 2022 MUC List.
¨ Ambulatory Surgical Center Quality Reporting Program (ASCQR) ¨ End-Stage Renal Disease Quality Incentive Program (ESRD QIP) ¨ Home Health Quality Reporting Program (Home Health QRP) ¨ Hospice Quality Reporting Program (HQRP) ¨ Hospital-Acquired Condition Reduction Program (HACRP) ¨ Hospital Inpatient Quality Reporting Program (Hospital IQR Program) ¨ Hospital Outpatient Quality Reporting Program (Hospital OQR Program) ¨ Hospital Readmissions Reduction Program (HRRP) ¨ Hospital Value-Based Purchasing Program (HVBP) ¨ Inpatient Psychiatric Facility Quality Reporting Program (IPFQR) ¨ Inpatient Rehabilitation Facility Quality Reporting Program (IRFQRP) ¨ Long-Term Care Hospital Quality Reporting Program (LTCHQRP) ¨ Medicare Promoting Interoperability Program (PI) ¨ Medicare Shared Savings Program ¨ Merit-based Incentive Payment System (MIPS) ¨ Part C and D Star Rating (Part C and D) ¨ Prospective Payment System-Exempt Cancer Hospital Quality Reporting Program (PCHQRP) ¨ Rural Emergency Hospital Quality Reporting Program (REHQRP) ¨ Skilled Nursing Facility Quality Reporting Program (SNFQRP) ¨ Skilled Nursing Facility Value-Based Purchasing Program (SNFVBP)
You can access the newly published at Overview of the Measures Under Consideration List for 2022 and the Measures Under Consideration List for 2022. The latter link is an Excel spreadsheet with 3 pages:
- Number of MUC Measures by Program
- MUC List, 2022 Measures
- MUC List, 2022 by Program
Home Health has 2 such measures:
- Cross-Setting Discharge Function Score. This outcome measure estimates the percentage of Home Health (HH) Medicare patients who meet or exceed an expected discharge function score. This measure falls within the Person-Centered Care healthcare domain.
- COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date. This process measure assesses the percent of home health patients that are up to date on their COVID-19 vaccinations as defined by CDC guidelines on current vaccination. Up to date as defined by CDC is outlined at Stay Up to Date with Your COVID-19 Vaccines. This measure falls within the Safety healthcare domain.
SNF QRP has 3 measures under consideration:
- COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) (2022 revision)*. This is an outcome measure: Percentage of healthcare personnel who are considered up to date with recommended COVID-19 vaccines. This measure falls within the Safety healthcare domain.
- Cross-Setting Discharge Function Score. This is also an outcome measure: Estimates the percentage of Medicare Part A SNF stays that meet or exceed an expected discharge function score. This measure falls within the Person-Centered Care healthcare domain.
- COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date. This is a process measure, reporting the percentage of patients in a SNF that are up-to-date on their COVID-19 vaccinations per the Centers for Disease Control and Prevention’s (CDC) latest guidance during the selected quarter. The definition of up to date may change based on the CDC’s latest guidance and can be found on the CDC webpage, Stay Up to Date with Your COVID-19 Vaccines. This measure is based on data obtained from MDS discharge assessments during the selected quarter. This measure falls within the Safety healthcare domain.
SNF VBP has 5 measures under consideration:
- Percent of Residents Experiencing One or More Falls with Major Injury (Long-Stay). This is an outcome measure (1 year) reporting the percentage of long-stay residents in a nursing home who have experienced one or more falls resulting in major injury (defined as bone fractures, joint dislocations, closed head injuries with altered consciousness, or subdural hematoma) reported in the look-back period no more than 275 days prior to the target assessment. The long-stay nursing home population is defined as residents who have received 101 or more cumulative days of nursing home care by the end of the target assessment period. This measure uses data obtained from OBRA, PPS and/or discharge MDS assessments during the selected quarter(s). This measure falls within the Safety healthcare domain.
- Cross-Setting Discharge Function Score. This outcome measure estimates the percentage of Medicare Part A SNF stays that meet or exceed an expected discharge function score. This measure falls within the Person-Centered Care healthcare domain.
- Skilled Nursing Facility (SNF) Within-Stay (WS) Potentially Preventable Readmissions (PPR) Measure*. This is an outcome measure: Estimating the risk-standardized rate of unplanned, potentially preventable readmissions that occur during SNF stays among Medicare fee-for-service [FFS] beneficiaries. This measure applies two substantive refinements to the original measure (described in detail with the numerator and denominator), which was submitted and published to the MUC List in 2015 and finalized in the fiscal year (FY) 2017 SNF PPS final rule for use in the SNF VBP program in 2016. The measure is calculated using two years of Medicare FFS claims data. This measure falls within the Seamless Care Coordination healthcare domain.
- Number of hospitalizations per 1,000 long-stay resident days. This outcome measure provides the number of unplanned hospitalizations, including observation stays, for long-stay residents per 1,000 long-stay resident days. For this measure, long-stay resident days are all days after the resident’s 100th cumulative day in the nursing home. This measure is part of the Affordability and Efficiency healthcare domain.
- Total nursing staff turnover. This is a structure measure: Percent of nursing staff that stop working in a facility within a given year. This measure falls within the Person-Centered Care healthcare domain.
*This measure is not new to the program but has been resubmitted for consideration due to substantive changes to measure specifications.
We’ll hear more about these MUCs in the coming year.