2017 IPPS final rule and claims-based measures

Why This Topic Matters

The article matters because it shows how claims-based performance measures can affect future hospital reimbursement and quality outcomes. It helps readers understand the kinds of rule changes that may influence coding, documentation, and performance monitoring over multiple program years.

Article Sections

1. Risk-standardized readmission rates

   Discusses readmission-related measure updates tied to Medicare reimbursement and the timing of performance windows. The section places the changes in the context of future program years and claims-based measure lag periods.

2. Risk-adjusted PSI 90 composite

   Covers changes to the PSI 90 composite used in hospital quality programs, including refinements to the measure structure and scoring approach. It also addresses timing changes and program-specific adoption plans.

3. Risk-standardized mortality measures

   Reviews mortality measure updates for hospital quality programs, including cohort expansion and revised assessment periods. The section also notes alignment across related measures and future program years.

4. Cost measures

   Summarizes updates to hospital payment measures in the efficiency and cost domain, including additional measures and cohort changes. It also covers the general approach used to score these measures.

5. Summary

   Provides a high-level wrap-up of how the rule affects hospital reimbursement and why claims-based measures matter to CDI and coding teams. It emphasizes the role of documentation and historical performance review.