Payment to Hospitals for Inpatient Hospital Services40
An eligible hospital will be treated as a meaningful EHR user, and thus eligible for increased payments,41 if the hospital demonstrates that during an EHR reporting period for a payment year, the hospital is using certified EHR technology in a meaningful manner,42 that such certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination,43 and, using certified EHR technology, the hospital submits information for such period on such clinical quality measures as selected by the Secretary.44 The Secretary will post on CMS’ website a list of the names of the eligible hospitals that are meaningful EHR users after ensuring that an eligible hospital has the opportunity to review the data.45
The Secretary will establish a value-based purchasing program under which incentive payments are made to hospitals that meet performance standards established by the Secretary46 with respect to the quality measures selected by the Secretary47 for inpatient hospital settings other than readmissions,48 which will include levels of achievement and improvement.49 Under this program, the Secretary will make available to the public the information regarding performance under the Program,50 including the performance of the hospital with respect to each measure that applies to the hospital;51 the performance of the hospital with respect to each condition or procedure;52 and the hospital performance score assessing the total performance of the hospital.53 Such information will be posted on the Hospital Compare website.54
In order to provide an incentive to applicable hospitals55 to reduce hospital acquired conditions, 56 the Secretary will adjust payments to hospitals.57 The Secretary will annually provide confidential reports to applicable hospitals with respect to hospital acquired conditions of the applicable hospital.58 The Secretary will make information available to the public regarding hospital acquired conditions of each applicable hospital,59 and will post such information on the Hospital Compare website.60
In operating the hospital readmissions reduction program, the Secretary will make information available to the public regarding readmission rates of each hospital in the program,61 and will post such information on the Hospital Compare website.62 The Secretary will calculate readmission rates for all patients for hospitals for an applicable condition63 and will post such information on the Hospital Compare website.64 Each specified hospital will submit to the Secretary, data and information necessary to calculate all patient readmission rates.65
Footnotes
- 40. Social Security Act § 1886, 42 U.S.C. 1395ww.
- 41. Social Security Act § 1886(n)(1), 42 U.S.C. 1395ww(n)(1).
- 42. Social Security Act § 1886(n)(3)(A)(i), 42 U.S.C. 1395ww(n)(3)(A)(i).
- 43. Social Security Act § 1886(n)(3)(A)(ii), 42 U.S.C. 1395ww(n)(3)(A)(ii).
- 44. Social Security Act § 1886(n)(3)(A)(iii), 42 U.S.C. 1395ww(n)(3)(A)(iii).
- 45. Social Security Act § 1886(n)(4)(B), 42 U.S.C. 1395ww(n)(4)(B).
- 46. Social Security Act §1886(o)(1)(A), 42 U.S.C. 1395ww(o)(1)(A).
- 47. Social Security Act §1886(o)(3)(A), 42 U.S.C. 1395ww(o(3)(A).
- 48. Social Security Act § 1886(o)(2)(A), 42 U.S.C. 1395ww(o)(2)(A).
- 49. Social Security Act § 1886(o)(3)(B), 42 U.S.C. 1395ww(o)(3)(B).
- 50. Social Security Act § 1886(o)(10)(A)(i), 42 U.S.C. 1395ww(o)(10)(A)(i).
- 51. Social Security Act § 1886(o)(10)(A)(i)(I), 42 U.S.C. 1395ww(o)(10)(A)(i)(I).
- 52. Social Security Act § 1886(o)(10)(A)(i)(II), 42 U.S.C. 1395ww(o)(10)(A)(i)(II).
- 53. Social Security Act § 1886(o)(10)(A)(i)(III), 42 U.S.C. 1395ww(o)(10)(A)(i)(III).
- 54. Social Security Act § 1886(o)(10)(A)(iii), 42 U.S.C. 1395ww(o)(10)(A)(iii).
- 55. Definition of applicable hospital. Social Security Act § 1886(p)(2), 42 U.S.C. 1395ww(p)(2).
- 56. “Hospital acquired condition” is defined in Social Security Act § 1886(p)(3), 42 U.S.C. 1395ww(p)(3).
- 57. Social Security Act § 1886(p)(1), 42 U.S.C. 1395ww(p)(1).
- 58. Social Security Act § 1886(p)(5), 42 U.S.C. 1395ww(p)(5).
- 59. Social Security Act § 1886(p)(6)(A), 42 U.S.C. 1395ww(p)(6)(A).
- 60. Social Security Act § 1886(p)(6)(C), 42 U.S.C. 1395ww(p)(6)(C).
- 61. Social Security Act § 1886(q)(6)(A), 42 U.S.C. 1395ww(q)(6)(A).
- 62. Social Security Act § 1886(q)(6)(C), 42 U.S.C. 1395ww(q)(6)(C).
- 63. Social Security Act § 1886(q)(8)(A), 42 U.S.C. 1395ww(q)(8)(A).
- 64. Social Security Act § 1886(q)(8)(B), 42 U.S.C. 1395ww(q)(8)(B).
- 65. Social Security Act §1886(q)(8)(C)(i), 42 U.S.C. 1395ww(q)(8)(C)(i).
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