CMS seeks public comments on cardiac outcomes measures

The Centers for Medicare & Medicaid Services (CMS) has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to develop two cardiac outcomes measures based on registry and/or claims data and designed for potential use in public reporting and pay-for-reporting of hospital quality. 

In partnership with the American College of Cardiology (ACC), the YNHHSC/CORE is developing the following measures:

• Complications following implantable cardioverter-defibrillator (ICD) implantation. The measure uses data from the ACC National Cardiovascular Disease Registry (NCDR) ICD registry for risk adjustment and Medicare Part A inpatient and outpatient administrative claims data to assess complications.
• Readmission following PCI. The measure uses data from the ACC NCDR CathPCI registry for risk adjustment and Medicare Part A inpatient and outpatient administrative claims data to assess readmissions.

These are the third and fourth registry-based measures CMS has developed with ACC. CMS previously developed PCI mortality measures using ACC's CathPCI Registry, which are currently under review at the National Quality Forum (NQF).

CMS is requesting that stakeholders review and submit public comment of the measures still under development. The agency said all comments are welcome, but it is particularly interested in the following areas:

• Outcome definitions and time period of assessment;
• Risk adjustment strategy; and
• Technical Expert Panel (TEP) feedback.

Comments can be posted here and will be accepted through Aug. 25. CMS will post a summary of all the comments in the Download section of the comment page within four weeks after the public comment period closes.

To date, there are no comments on the first measure regarding complications following ICD implantation. Some comments on the second measure regarding readmission after PCI include:

• concerns about readmission due to patient noncompliance;
• concerns about tort reform before readmission rates can be lowered for patients who return with noncardiac sources of chest pain;
• the suggestion that this area of interventional cardiology has excellent outcomes and the money for this project could be better spent evaluating outcomes for primary prevention, emergency room treatment, and atrial fibrillation and congestive heart failure treatment; and
• the need to take into account the wide variation of complexity of cases.