News: PSI 90's transformation

The fiscal year (FY) 2017 IPPS proposed rule included some significant changes to Patient Safety Indicator (PSI) 90, one of which is a new name: The Patient Safety and Adverse Events Composite. A fact sheet recently released by the measure's owner, the Agency for Healthcare Research and Quality (AHRQ), provides insights into what may lie ahead if the proposed rule's content is finalized.

 The underlying objective of this measure remains the same—to provide an overview of hospital-level quality as it relates to a set of potentially preventable hospital-related events associated with harmful outcomes for patients.

The measure will also continue to be included in the following CMS hospital pay-for-performance programs:

• The Hospital-Acquired Condition Reduction Program (HACRP) will adopt the measure in FY 2018
• The Hospital Value-Based Purchasing Program will adopt the measure in FY 2019 after the statutorily required one-year public posting of performance on CMS Hospital Compare under the Inpatient Quality Reporting Program
• PSI performance will still be assessed using an observed over expected ratio, and the risk adjustment methodology will remain the same, although comorbidity variables and coefficient weights will likely be refined

PSIs in the CMS composite will change, however, to remove PSI 7, central-line associated blood stream infection and three other PSIs (8, 12, and 15) will be re-specified, which means that the types of patients included in the PSIs will be revised.

Although the HACRP will adopt this modified measure in FY 2018, performance will be based on today's discharges. Therefore, CDI programs should begin to review the revised measure specifications and risk adjustment variables. The challenge: The ICD-10-ready specifications for this modified version will not be ready until sometime this summer, and the risk adjustment variables are not anticipated to be ready until next year. AHRQ is evaluating ICD-10 data in its databases to finalize this information.

CDI programs that have already established the infrastructure to monitor and effectively impact claims-based quality measures are likely positioned well to navigate these changing waters.

Editor's note: This article was originally published in JustCoding and was written by Shannon Newell, RHIA, CCS. Newell is the director of CDI quality initiatives for Enjoin and can be reached at shannon.newell@enjoincdi.com. Opinions expressed are that of the author and do not represent HCPro or ACDIS. Additional information can be located here and here.