The main changes for 2012 that affect emergency medicine include the removal of AMI-1: Aspirin at Arrival from the list because it was felt that the vast majority of hospitals now perform well on this measure and the measure has served its purpose. Also, PN-5c: Initial Antibiotic Received within 6 Hours of Arrival will be removed. In 2014, both the median time from arrival to departure for admitted patients and the median time from admit decision to departure for admitted patients (i.e., the boarding measure) will take effect. However, if hospitals desire to receive “meaningful use” incentives starting in 2011 according to the HITECH Act, they will need to begin reporting these measures immediately.

Also included in the Final Rule was the initial framework for the Hospital Readmission Reduction Program (HRRP), which is set to begin in FY 2013. Unlike other measures in the Hospital IQR, hospitals will be penalized for high readmission rates (compared with a baseline period from July 1, 2008, to June 30, 2011) for applicable conditions, initially including heart failure, pneumonia, and acute myocardial infarction. For the first year of the program, payment reductions will be capped at a maximum of 1% of inpatient payments. The payment reduction rates will increase by 1% each year, capping at 3% for FY 2015 and beyond. In FY 2015, the list of applicable conditions will expand to include other high-volume and high-cost conditions, likely COPD, CABG, PTCA, and other vascular procedures (Table 5).

National Quality Forum (NQF)

Historically, the final common pathway for quality measure endorsement has been approval by a voluntary consensus standards-setting organization that CMS has deemed necessary for inclusion into the IPPS and OPPS programs. The National Quality Forum (NQF) has become the de facto quality measure endorsement organization. In addition, CMS contracts with NQF to identify and vet certain measure sets. Table 6 lists the NQF-endorsed measures in both Phase 1 and Phase 2 of the Voluntary Consensus Standards for Ambulatory Care that mainly affects emergency care, with the most recent phase being adopted in January 2011.

One particularly contentious measure worth noting is OP-15 or Use of Brain Computed Tomography (CT) in the Emergency Department for Atraumatic Headache. OP-15 will be the first measure that has been fast tracked for inclusion into the OPPS program despite NQF rejection. Through its Quality and Performance Committee, ACEP has sent comments challenging this unprecedented path as well as the validity of this measure. A coordinated national study is nearly complete to evaluate how the OP-15 measure derived from administrative claims data compares with actual clinical data derived from chart review, as well as compliance with other established guidelines for CT utilization in atraumatic headache.