Postoperative respiratory failure's introduction into the CMS value-based reimbursement model

Why This Topic Matters

Hospitals and CDI teams may be evaluated and reimbursed based on how accurately postoperative respiratory failure and related events are documented and reported. Understanding the article helps readers assess whether their documentation practices support accurate quality measurement and risk adjustment.

Article Sections

1. Introduction

   Introduces the article’s focus on documentation, claims data, and their relationship to reimbursement and data quality in a hospital quality-measure context.

2. Performance may impact reimbursement in FY 2018

   Summarizes the hospital value-based reimbursement context and the role of a patient safety composite tied to PSI 11 performance.

3. Data quality and PSI 11 performance

   Describes how PSI 11 is measured and outlines the broad categories of discharges, events, and procedure reporting that affect the measure.

4. PSI 11 CDI vulnerabilities

   Reviews common documentation and record-review challenges that can affect the accuracy of PSI 11-related data.

5. How do I recognize acute respiratory failure?

   Discusses general clinical recognition of respiratory failure and the types of indicators used to support documentation review.

6. What is the definition of “prolonged” post-operative mechanical ventilation?

   Addresses documentation and review issues related to identifying prolonged ventilatory support after surgery.

7. If the patient is extubated post-operatively, but continues to be treated with supplemental oxygen, when is a query for acute respiratory failure appropriate?

   Explains the broader documentation review considerations involved when supplemental oxygen is used after extubation.

8. When respiratory failure exists in a post-procedural patient, how do I determine if this is, and/or is not, related to the procedure?

   Covers general documentation clarity issues around linking respiratory failure to an underlying condition, procedure, or anesthesia.

9. Summary

   Concludes with broad recommendations for coordinating CDI, quality, physician education, and risk-adjustment capture.