CMS Validated Hospital Inpatient Quality Reporting Program Data, But Should Use Additional Tools to Identify Gaming

Source: Department of Health and Human Services, Office of the Inspector General, OEI-01-15-00320, April 2017

For payment year 2016, CMS met its regulatory requirement by validating sufficient IQR data, which are used to adjust payments on the basis of quality. Almost 99 percent of hospitals that CMS reviewed passed validation, and CMS took action against the six that failed, including reducing their Medicare payments. In addition, CMS and CDC offer training to hospitals to help improve the accuracy of the quality data that hospitals report. However, CMS’s approach to selecting hospitals for validation for payment year 2016 made it less likely to identify gaming of quality reporting (i.e., hospitals’ manipulating data to improve their scores). CMS did not include any hospitals in its targeted sample on the basis of their having aberrant data patterns. Targeting hospitals with aberrant patterns for further review could help identify inaccurate reporting and protect the integrity of programs that make quality-based payment adjustments.
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