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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
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collection burden, outweigh benefits is inconsistent.
Response: We evaluate measures on a case-by-case basis looking at the overall benefits of the measure versus the overall costs of the measure. Therefore, measures are not evaluated based on whether they are more or less burdensome than other measures.
However, we now believe that the benefits of retaining this measure are greater than we had considered in our proposal to remove the measure from the IPFQR Program measure set.
After consideration of the public comments, we now believe that the benefits of retaining this measure, which include the potential for IPFs to continue improving performance on this measure, the importance of tobacco use interventions due to increased tobacco use during the COVID19 pandemic, and this measures potential influence on other quality improvement activities related to tobacco use, are greater than we had considered in our proposal to remove the measure from the IPFQR
Program measure set. Accordingly, we are not finalizing our proposal to remove the Tobacco Use Treatment Provided or Offered and Tobacco Use Treatment TOB2/2a measure beginning with the FY 2024 payment determination. That is, we are retaining the Tobacco Use Treatment Provided or Offered and Tobacco Use Treatment TOB2/2a measure in the IPFQR
Program measure set.
c. Removal of the Timely Transmission of Transition Record Discharges From an Inpatient Facility to Home/Self Care or Any Other Site of Care Measure Beginning With FY 2024 Payment Determination We proposed to remove the Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure from the IPFQR Program beginning with the FY 2024 payment determination under our measure removal Factor 8, The costs associated with a measure outweigh the benefit of its continued use in the program.
We adopted the Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure in the FY 2016 IPF PPS final rule 80 FR
46706 through 46709 because more timely communication of vital information regarding the inpatient hospitalization results in better care, reduction of systemic medical errors, and improved patient outcomes. The Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other
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Site of Care measure builds on the Transition Record with Specified Elements Received by Discharged Patients Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure, which requires facilities to provide a discharge record with 11 specified elements to patients at discharge.
We continue to believe that the 11
elements required by the Transition Record with Specified Elements measure provide meaningful information about the quality of care provided by IPFs, and we therefore did not propose to remove that measure from the IPFQR Program. However, we believe that the benefits of requiring facilities to transmit the discharge record with 11 specified elements to the next level care provided within 24
hours, as required by the Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure, have been reduced.
Reporting this measure requires facilities to chart-abstract measure data on a sample of IPF patient records, in accordance with established sampling policies 80 FR 46717 through 46719.
On May 1, 2020, we updated the Conditions of Participation CoPs for IPFs participating in the Medicare program in the Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP
Managed Care Entities, Issuers of Qualified Health Plans on the Federally Facilitated Exchanges, and Health Care Providers final rule 85 FR 25588.
In the May 1, 2020 update to the CoPs, we adopted a requirement for psychiatric hospitals that possess EHR
or other administrative systems with the technical capacity to generate information for electronic patient event notifications to send electronic patient event notifications of a patients admission, discharge, transfer to another health care facility or to another community provider, or combination of patient events at the time of a patients discharge or transfer. Because these updated CoP requirements overlap with, but are not the same as, the requirements for the Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure which requires transmission of a discharge record with 11 specified elements to the next level care provider within 24 hours of the patients discharge rather that requiring
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notification regarding the patients inpatient stay to be transmitted at discharge, we believe that the adoption of these updated CoPs increases the costs of the Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure while decreasing its benefit. Specifically, we believe that the costs of this measure are increased because facilities to which the new CoPs apply that is, facilities that possess EHR or other administrative systems with the technical capacity to generate information for electronic patient event notifications as defined in the CoP could bear increased cost if they separately implement the patient event notifications meeting both the criteria for the updated CoPs and the capacity to share a transition record that meets the requirements of our measure.
We noted that the updated CoPs do not include the level of detail regarding data to be transferred at discharge that our Timely Transmission of Transition Record Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure requires. While the set of information in the CoP
notification policy is a minimal set of information, we believe that it would continue to be appropriate for providers to transmit the transition record that they will continue to be providing to patients under our Transition Record Received by Discharged Patients Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care measure, we further note that the CoPs referenced in the proposed rule are not an exhaustive list of data transfer requirements.
We believe the different requirements regarding both timeliness of notification and contents of notification could lead some providers to send two separate discharge notifications to meet the separate requirements. Further, we believe that the benefits of the measure are reduced because all facilities to which the new CoPs apply will be sending patient discharge information to the next level of care provider as required by the CoPs. Therefore, the benefits of this measure are reduced because it is less likely to ensure that these facilities provide patient discharge information to the next level care provider, and it is less likely to provide information to help consumers differentiate quality between facilities.
While these updated CoPs do not directly address transmission of patient event notifications for facilities that do not possess EHR systems with the capacity to generate information for electronic patient event notifications,
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