AHA pushes back on CMS IPPS quality proposals including SEP-1, HAC Reduction Program

By Brian Murphy

As we sit in the waiting period between the IPPS proposed rule and the final rule (likely out in August), I took a look at the American Hospital Association’s comments. So that you didn’t have to. Link below.

As a reminder CMS welcomes public comments as part of its rulemaking process. In my ACDIS days I worked with the advisory board and later the regulatory committee to comment on the final rules. And on a few occasions our words were recognized, and led to change.

But the AHA is the big player in this space (nearly 5,000 hospitals, health care systems, networks, other providers of care) and their comments weigh heavily.

We know that CMS is trying to tie payment to quality through value-based purchasing. Which sounds great, but the devil is in the details. For example:

How do you actually measure quality from documentation and coded data?

How much influence does CMS have on how care is practiced? How much should they?

The answer of course is this is a partnership, a dance. Hospitals practice medicine, but CMS is in the business of coverage and payment. There will be tension, but both require the other.

Here are a couple comments from the AHA related to quality that I found interesting.

👉 Addition of Severe Sepsis and Septic Shock Management Bundle (SEP-1). CMS proposed to add the SEP-1 measure used in the IQR program to the HVBP’s safety domain in FY 2026, consistent with its renewed focus on patient safety.

The AHA disagrees, citing no evidence of improved outcomes with SEP-1. “Furthermore, SEP-1’s focus on immediate administration of antibiotics has the high potential to lead to excessive use of antibiotics,” according to the AHA.

👉 General critique of the HAC Reduction Program. We’ve all heard of carrots and sticks as a mechanism for changing behavior, but a deserved critique of the HAC Reduction Program is its all penalties and no rewards. The AHA lets CMS have it:

“As a general matter, the AHA is not confident the HAC Reduction Program is a particularly effective mechanism for promoting advances in patient safety. In fact, the AHA has long opposed the statutory design of the HAC Reduction Program, which imposes penalties on up to 25 percent of hospitals each year, regardless of whether hospitals have improved performance, and regardless of whether performance across the field is consistently good. Peer-reviewed research has shown that the program’s design unfairly penalizes teaching hospitals, large hospitals, small hospitals and hospitals caring for structurally marginalized communities. Additional research has also demonstrated that the performance of hospitals receiving the penalty often is statistically indistinguishable from those who are not, suggesting that the use of a penalty threshold is arbitrary.”

The AHA also wants CMS to sunset PSI 90 from the HAC Reduction Program entirely.

Will we see SEP-1 added? Will CMS make any meaningful reforms to the HAC program?

We’ll see what we get in August.

Resources

Read AHA comments here: https://www.aha.org/system/files/media/file/2023/06/aha-comment-letter-on-inpatient-prospective-payment-system-fy-2024-proposed-rule-6-9-2023.pdf