Special Studies
MPRO has conducted a variety of special studies for the Centers for Medicare & Medicaid Services (CMS). These special studies have been subject to much attention in Michigan and across the nation.
Hospital Payment Monitoring Program (HPMP)
HPMP Studies
The Hospital Payment Monitoring Program (HPMP) was a nationwide effort by CMS to protect the Medicare trust fund by ensuring that Medicare pays for services that are reasonable and medically necessary. The long-term goal of HPMP is to help inpatient prospective system hospitals prevent payment errors by analyzing data, conducting focused audits, and implementing system changes to ensure payment accuracy.
In 2006, CMS awarded MPRO an HPMP special project entitled “Reduction of Payment Errors for One-day Hospital Stays.” The goal of this project was to decrease the proportion of payment error cases in one-day lengths of stays (LOS) by 5% for acute care prospective payment system (PPS) hospitals in the state of Michigan. Also, MPRO will increase provider and physician awareness of the one-day LOS payment error pattern and trend related to inappropriate one-day stays. MPRO accomplished these objectives through focused interventions (i.e. data dissemination, guideline distribution, and staff education) targeted at 15 hospitals identified from data analysis as having a high volume of discharges and a high proportion of one-day stays.
MPRO also conducted two special projects as part of the HPMP: “Unnecessary Short-stay Admissions with Discharge to a Skilled Nursing Facility” (also referred to as UNA-05) and “National Payment Error (NPE) Unnecessary Admissions” (known as UNA-06). The Unnecessary short-stay Admissions project utilized an onsite educational visit for 10 targeted hospitals to assist in identifying causes of the inappropriate admissions and a collaborative with three learning sessions based on the Institute for Health (IHI) model. Post-interventions, MPRO reviewed selected admissions from each hospital to determine the medical necessity of admission, the quality of care and correct DRG coding. Study results indicated that the interventions were effective in reducing the rate of unnecessary admissions. The payment error rate of 33.3% at baseline was reduced to 13.4% at remeasurement. These results represent a 19.9% absolute improvement in the error rate.
UNA-06 utilized onsite visits for case review and education for ten targeted hospitals to assist in improving their admission screening process. Study results demonstrated a statistically significant reduction in the failure rates. The error rate was reduced from 73.1 percent at baseline to 50.3 percent at remeasurement. This reduction represented a 22.8 percent reduction in the absolute failure rate and 31.2 percent reduction in the relative failure rate. MPRO estimates that this reduction in payment errors has saved and will continue to save about $500,000 per year for the Medicare Trust Fund.
Depression Special Study
In 2001, CMS awarded MPRO a special study grant to conduct a study in which MPRO provided guidance to nursing homes in developing effective depression screening and management processes. Entitled “Improving Screening & Management of Depression in the Skilled Nursing and Long Term Care Setting,” the study demonstrated the effectiveness that the Minimum Data Set (MDS) in long-term care settings can be used for quality improvement projects. During the project, MPRO was guided by a Technical Expert Panel (TEP) established by CMS, a project team of clinical experts, local champions in the nursing home community, and clinical members involved in the American Medical Directors Association (AMDA) at the state and national levels.
Nursing homes were highly motivated to participate in the study because of the recognized prevalence of depression within the geriatric population (focus groups estimated prevalence at 33-90%). As a result of the project, significant improvements in quality indicator percentages relating to depression screening and management were observed.
To learn more about MPRO’s Special Studies contact: webmaster@mpro.org.
