Healthcare innovation

CMS Proposing Inpatient Social Risk Screening Quality Measures

CMS Proposing Inpatient Social Risk Screening Quality Measures

The Centers for Medicare & Medicaid Services is proposing two social risk screening quality measures in its Fiscal Year 2023 Hospital Inpatient Prospective Payment System (IPSS) and is also seeking input about use of social risk data as part of the clinical severity classification and quality measures stratification.

The May 2022 newsletter from the Social Interventions Research & Evaluation Network (SIREN) located at UCSF notes that the proposed rule is open for comment until June 17.

The Hospital Inpatient Quality Reporting (IQR)Program is a pay-for-reporting quality program that reduces payment to hospitals that fail to meet program requirements. Hospitals that do not submit quality data or fail to meet all Hospital IQR Program requirements are subject to a one-fourth reduction in their Annual Payment Update under the IPPS.

In the 2023 proposed rule, CMS is proposing to add two measures related to social risk screening to the IQR program:

• “Screening for Social Drivers of Health,” which measures the percent of adult inpatient patients who are screened, on their date of admission, for at least one of the following social risks: food insecurity, housing instability, transportation needs, utility needs, and interpersonal violence. (Patients who opt out of screening would be excluded from the denominator for this measure.)

• “Screen Positive Rates for Social Drivers of Health,” which would be 5 measures that capture the percent of screened adults who screen positive for each of the above 5 social risks (one measure per social risk).

CMS is proposing that these measures be optional for calendar year 2023, and mandatory beginning with the calendar year 2024 reporting period. Hospitals could use the screening tool and approach of their choice. CMS welcomes comments on this proposal.

CMS also is seeking public comment on how the reporting of ICD-10 diagnosis codes in categories Z55-Z65 (“Z-codes”) may improve CMS’ ability to recognize severity of illness, complexity of illness, and/or utilization of resources and how CMS could foster the documentation and reporting of Z codes.

SIREN noted that as part of a Request for Information related to measuring disparities in healthcare quality, CMS is seeking comments about selection and use of social risk factor data to use in stratifying quality measures. Specifically, CMS seeks feedback on “principles for the selection of social risk factors and demographic data for use measuring disparities, include the importance of identifying new social risk factor and demographic variables to use to stratify measures. CMS also seeks comment on the use of imputed and area-based social risk and demographic indicators for measure stratification when patient reported data are unavailable.”