Impact Of The 2015 CMS Inpatient Psychiatric Facility Quality Reporting (IPFQR) Rule On Tobacco Treatment

Abstract

Objective: In its fiscal year (FY) 2015 final rule, the Centers for Medicare & Medicaid (CMS) required reporting of tobacco treatment quality measures as part of the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). This study evaluates the impact of that policy at a large academic medical center that opted to improve performance as it implemented reporting measures. Methods: Electronic medical record data were collected retrospectively for all inpatient psychiatric admissions one year prior to and following implementation of the rule (Jan 1st 2014 to December 31st 2015). Data from admissions (2014=292; 2015=338) were analyzed to determine changes in the provision of tobacco treatment including the proportions of patients screened for tobacco use, receiving tobacco cessation counseling, and receiving tobacco cessation medication(s). Results: Compared to the year before the CMS rule, screening for admissions increased significantly (85% vs 97%; p<.001). Even greater pre-post rule increases were found for referral to cessation counseling (4.3% vs. 73.8%; p<.001),reciept of counseling (7.8% vs. 67.1%; p<.001) and referral for cessation medication (32% vs. 68.4%; p<.001). Even though statistically non-significant, the number of tobacco users who actually received medications increased markedly between 2014 and 2015 (24.3% vs. 34.9%; p=0.064). Gains in screening, referral, and treatment did not differ by psychiatric diagnosis. Conclusions: The IPFQR Program resulted in dramatic changes in tobacco-related screening, documentation, and cessation treatment for psychiatric inpatients. Should CMS link prospective payment to performance, it could have a major impact on quality of care for tobacco dependence.