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Acmeware Achieves 100% Submission Success
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Acmeware completes 100% successful submissions for eCQM, PQRS, Hospital IQR, and Joint Commission ORYX using OneView for acute and ambulatory settings.
TL/DR
Inpatient Psychiatric Facilities must comply with both CMS IPFQR and Joint Commission quality reporting requirements. Non-compliance results in a 2.0 percentage point payment reduction.
- Ten chart-abstracted measures required for CY 2022, including HBIPS-2, HBIPS-3, HBIPS-5, transition records, metabolic screening, and substance use measures
- Additional reporting includes COVID-19 HCP vaccination, claims-based measures, and non-measure discharge data
- Joint Commission requires quarterly HBIPS measure reporting for accredited facilities
- 2022 specification changes affect tobacco measures (TOB-2/3) and influenza immunization (IMM-2) exclusion criteria
A comprehensive guide to CY 2022 IPFQR chart-abstracted measures, claims-based measures, and Joint Commission reporting requirements.
Article content
The Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) oversee quality reporting initiatives for Inpatient Psychiatric Facilities (IPFs). These programs aim to encourage facilities and providers to improve the quality of inpatient care and inform consumers.
IPFs must comply with CMS's Inpatient Psychiatric Facility Quality Reporting Program (IPFQR), which operates as a pay-for-reporting initiative. Facilities that fail to participate or meet reporting requirements face a 2.0 percentage point reduction of their annual update to their standard federal rate.
Chart-Abstracted Measures for 2022
Required measures for CY 2022 reporting (submission July 1 through August 15, 2023) include:
- HBIPS-2: Hours of Physical Restraint Use
- HBIPS-3: Hours of Seclusion Use
- HBIPS-5: Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification
- TR-1: Transition Record with Specified Elements Received by Discharged Patients
- SMD: Screening for Metabolic Disorders
- SUB-2/SUB-2a: Alcohol Use Brief Intervention Provided or Offered
- SUB-3/SUB-3a: Alcohol and Other Drug Use Disorder Treatment Provided or Offered at Discharge
- TOB-2/TOB-2a: Tobacco Use Treatment Provided or Offered
- TOB-3/TOB-3a: Tobacco Use Treatment Provided or Offered at Discharge
- IMM-2: Influenza Immunization (October 1, 2022 through March 31, 2023)
Additional IPFQR Components
Beyond chart-abstracted measures, facilities must report:
- COVID-19 Vaccination Coverage Among Health Care Personnel
- Claims-based measures (Follow-Up After Psychiatric Hospitalization; 30-Day All-Cause Unplanned Readmission; Medication Continuation)
- Non-measure data (Total Annual Discharges; Discharges by Age, Diagnosis Code, and Payer)
Joint Commission Requirements
TJC-accredited IPFs must report quarterly on Hospital-Based Inpatient Psychiatric Services (HBIPS) measures:
- HBIPS-1: Admission screening for violence risk, substance use, psychological trauma history and patient strengths completed
- HBIPS-2: Hours of Physical Restraint Use
- HBIPS-3: Hours of Seclusion Use
- HBIPS-5: Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification
2022 Specification Changes
Tobacco measures (TOB-2/2a and TOB-3/3a) underwent revisions. "Light Smokers" were removed from numerator excluded populations. Documentation updates address conflicting tobacco use status and concurrent daily/sporadic use.
The IMM-2 measure was updated to include additional exclusion criteria, including patients with anaphylactic allergies, recent bone marrow transplants, Guillain-Barre history, or symptomatic COVID-19.
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