New Measure – The Information Transfer PRO-PM
Of the new items proposed in the measure, what stood out to CODE Technology is the Information Transfer PRO-PM. As you know – WE LOVE PROs! The new measure’s aim is to evaluate how effectively healthcare facilities communicate discharge instructions to patients.
Why Is It Important?
Research shows 3 key items related to discharge instructions:
- Patients who receive well-communicated discharge instructions have lower readmission rates and fewer follow-up calls to their providers
- Patients receive better discharge instructions when they have surgery in an inpatient setting compared to those who have outpatient surgery
- Clear discharge instructions and improved patient outcomes are linked
With outpatient surgeries on the rise it’s essential to assess how well outpatient providers are meeting this need.
What is the Information Transfer PRO-PM?
The Information Transfer PRO-PM tool focuses on capturing patients’ perceptions of how effectively discharge information was communicated and understood, giving them a voice in the process.
The survey consists of nine questions that cover three key areas: medications, applicability, and daily activities. It’s sent to patients 2 to 7 days after their procedure. The survey evaluates the entire process, from surgery scheduling to discharge, including pre-op visits, post-op packets, phone calls, or conversations with staff.
Who is Eligible?
Any patient 18 years or older who had a surgery or procedure at an outpatient facility is eligible. They must be discharged alive and have a stay of less than 2 midnights, calculated by subtracting the discharge date from the admission date and dividing by 24.
Data Sources
The data for this analysis is calculated based on patient-reported outcome data collected by hospitals, either directly or through vendors who distribute the surveys to patients. Patients are given a 65-day window to respond to the survey, providing ample time for thoughtful and comprehensive feedback.
To ensure the data’s reliability and representativeness, a minimum random sample of 300 completed surveys is required. In cases where hospitals are unable to collect the minimum number of surveys, they are required to submit data on all completed surveys available, and must have 100 for it to be scored. This approach ensures that even smaller hospitals or those with lower patient volumes contribute valuable data to the overall analysis. [Slide 27 Entitled Data Source from CMS presentation]
Measure Specifications
The survey uses a continuous variable scoring methodology where a higher score indicates better quality.
- Denominator: Total number of patients who completed the survey. Those who are sent the survey but do not respond are removed from the denominator. For each patient in the denominator, individual scores are calculated. The individual score is calculated for each respondent by summing the items to which they responded positively with “Yes” or “Very Clear” and then dividing this sum by the total number of items that respondents found applicable to their procedure or surgery. Applicable items are determined by subtracting the sum of items marked as “Does not apply” from the total number of items, which is 9 for this instrument.
- Numerator: This is calculated by summing all individual scores from eligible respondents. Specifically, it involves adding up the items to which the respondent gave a positive response of “Yes” or “Very Clear” and then dividing this sum by the number of items the respondent deemed applicable (determined by subtracting the number of items for which the respondent said “Does not apply” from the total possible of 9 items surveyed). The facility’s measure score is the arithmetic mean of all individual scores calculated by dividing the numerator by the denominator. [Slide 28 Entitled Measure Specifications from CMS presentation]
The 9 Question Survey | PRO-PM Submission Documents
Survey Instrument – This is a brief survey that should take you 5 minutes.
You are receiving this survey because you recently had a procedure at [Facility Name]. Either before or after your operation you should have been given information about what to do during your recovery process. We would like to know if this information was easy-to-follow.
Your survey responses will help your doctors and hospital improve the quality of care they provide Your responses are completely anonymous, neither your name nor any other identifying information will be shared with your doctor or hospital. This survey can be filled out by you or your caregiver.
Information Took Into Account My Needs
The information you got about your recovery considered:
- Your health needs (for example: medical conditions, pain management, treatment preferences, etc.)
- Yes | Somewhat | No
- Your personal situation (for example: transportation needs, insurance coverage, financial status, etc.)
- Yes | Somewhat | No
Medications
How clear was the following information about your recovery:
- Why you should take any new medications
- Very clear | Somewhat clear | Not clear | Does not apply
- Possible side effects of new medications
- Very clear | Somewhat clear | Not clear | Does not apply
- When to stop any medications
- Very clear | Somewhat clear | Not clear |Does not apply
Daily Activities
How clear was the following information about your recovery:
- Changes to your diet
- Very clear | Somewhat clear | Not clear | Does not apply
- Changes to physical activities, including exercise.
- Very clear | Somewhat clear | Not clear | Does not apply
- When you could return to work
- Very clear | Somewhat clear | Not clear | Does not apply
- When you could drive
- Very clear | Somewhat clear | Not clear | Does not apply
Key Dates & Data Submission
Voluntary reporting starts CY 2026 | Mandatory reporting CY2027 | Payment Determinations CY 2029
Hospitals are required to use the Hospital Quality Reporting (HQR) system for the submission of any Patient-Reported Outcome Performance Measures (PRO-PM). They have the flexibility to either submit PRO-PM data directly to the Centers for Medicare & Medicaid Services (CMS) or utilize a third-party vendor. The HQR system supports multiple file formats and also offers a manual data entry option, making it versatile and user-friendly.
The reporting period for each measure spans from January 1 to December 31, two years prior to the applicable payment determination year. This timeline ensures that the data reflects a full calendar year of patient outcomes and hospital performance.
Hospitals must submit their data annually via the HQR system, with the submission window opening on January 1 and closing on May 15 of the following year. [Slide 29 Entitled Data Reporting and Submission from CMS presentation]
CMS Proposed Rule 2025 & Information Transfer PRO-PM
The Centers for Medicare and Medicaid Services (CMS) issued the CY 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. CMS estimates that, based on these proposed policies, total payments to OPPS providers and ASCs for CY 2025 will be approximately $88.2 billion and $7.4 billion, respectively. This represents an increase of about $5.2 billion and $202 million from CY 2024 payment levels.
Payment Rate Updates Proposed
CMS is proposing a 2.6% increase in payment rates for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASCs) for hospitals and ASCs that meet quality reporting requirements. Hospitals and ASCs that do not meet these requirements will face a 2% reduction in the CY 2025 fee schedule increase factor. For more information on the measure itself, please refer to our blogs – Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Overview, and an Introduction to CMS’s CY 2024 OPPS/ASC Proposed Rule & THA/TKA PRO-PM.
Final Thoughts on Information Transfer PRO-PM
The data is clear- well communicated discharge instructions lead to better patient outcomes. It is also well understood that patients who have surgery in the inpatient setting receive better discharge instructions than those who have surgery in the outpatient setting. If passed, the Information Transfer PRO-PM could provide facilities with the qualitative data necessary to understand the gaps in discharge education, and subsequently create systems and processes that improve the quality of care.
Simplify The Complexities Of The PRO-PM
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