IPPS rule: CMS proposes new ‘birthing friendly’ designation, along with PHE-related CoPs

CMS says it wants to expand COVID-19 and other infectious disease reporting requirements beyond the current public health emergency (PHE) as a way to stay prepared for the next pandemic.

That proposal, along with a plan to improve maternal mortality and care by designating hospitals who can meet certain criteria as “birthing friendly,” are part of the 1,786-page proposed FY2023 Inpatient Prospective Payment System rule released Monday, April 18. The rule is scheduled to be published on May 10.

In an effort to “ensure a nimble and informed response to the next potential pandemic or epidemic, so that we are able to immediately respond to the situation at hand,” CMS is proposing revising hospital Conditions of Participation on infection prevention and control “to extend the current COVID-19 reporting requirements and to establish new reporting requirements for any future PHEs related to a specific infectious disease or pathogen.”

The data categories are likely to include the current reporting as well as new categories as deemed necessary. The reporting could be weekly or daily, also depending on the situation, as deemed by the secretary of Health and Human Services, according to the prosed rule.

The information will also likely include information on influenza cases or other infectious diseases and will be detailed enough to identify a particular patient, says the proposal.  

CMS noted that the additional data reporting is expected to be costly in time and money. The agency said it estimated an average response time of 1.5 hours for weekly reporting and 3 hours for daily reporting. The cost estimate was $6,162 per facility for weekly reporting and $86,505 per facility for daily reporting.

“We believe that individual data elements such as race, ethnicity, age, sex, residential county and zip code, and relevant comorbidities for affected patients are necessary to address issues of health equity and response management,” says the proposal.

Details of the PHE reporting proposal can be found starting on page 1,395 of the online PDF.

The “birthing friendly” proposal, meanwhile, is designed to encourage hospitals to improve maternal mortality and to help consumers make choices about where they have their babies, says CMS.

The designation will be reported on a public website by CMS and initially will be given to hospitals who answer “yes” to both of the current maternal health reporting requirements outlined in last year’s Maternal Morbidity Structural Measure. The first designations will be published this fall.

Those two attestations capture whether “hospitals are: (1) participating in a structured state or national Perinatal Quality Improvement (QI) Collaborative; and (2) implementing patient safety practices or bundles as part of these QI initiatives,” according to a fact sheet on the proposed rule’s maternal health improvement effort.

CMS wants to eventually expand requirements for earning the “birthing friendly” designation to include other electronic clinical quality measures (eCQM).

While CMS is requesting information on future maternal healthcare requirements and quality measures, for now the newest proposed measures for the hospital inpatient quality reporting (IQR) program are on Cesarean births (ePC-02) and severe obstetric complications (ePC-07), according to the proposal.

The two measures are connected to the nationwide push by Congress, CMS, The Joint Commission, and other organizations to improve maternal healthcare, particularly for women of color.

According to the CDC, black and Indigenous women in the U.S. die from pregnancy-related causes “at a rate 2-3 times higher and experience severe maternal morbidity at a rate nearly two times higher than their White, Asian Pacific Islander, and Hispanic counterparts.”

The nation ranks last among the world’s wealthiest nations in maternal mortality and behind many Third World countries.

For more on the proposed quality measures, see pages 1,105-1,131.

Public comment on the entire proposed rule will be accepted through June 17, 2022, and can be made online or by mail. Find instructions on how to comment on page 2 of the rule.

The full rule can be found at: https://public-inspection.federalregister.gov/2022-08268.pdf