title: Impact of the 2015 CMS Inpatient Psychiatric Facility Quality Reporting Rule on Tobacco Treatment.
abstract: BACKGROUND
  In its fiscal year 2015 final rule, the Centers for Medicare & Medicaid Services (CMS) required reporting of tobacco treatment quality measures as part of the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS). This pre-intervention, post-intervention policy analysis 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 adult (≥18 years) inpatient psychiatric admissions from January 1, 2014 to December 31, 2015. Data from admissions 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) using a chi-square test. Covariate analysis of treatment differences based on psychiatric diagnosis was analyzed using Cochran-Mantel-Haenszel and Breslow-Day test.
  
  
  RESULTS
  Post-policy screening for admissions increased significantly (85% vs. 97%; p < .001). Referral to cessation counseling increased 18-fold (4% vs. 74%; p < .001). Receipt of Counselling (8% vs. 67%; p < .001) and referral for cessation medication (32% vs. 68%; p < .001) also increased dramatically. Though statistically non-significant, the number of tobacco users who actually received medications increased markedly between 2014 and 2015, 24% versus 35%. Gains in screening, referral, and treatment did not differ by psychiatric diagnosis.
  
  
  CONCLUSIONS
  The Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program resulted in a 10-fold increase in the number of smokers who received inpatient tobacco treatment. Should CMS link prospective payment to performance, it could have a major impact on quality of care for tobacco dependence.
  
  
  CONCLUSIONS
  This is the first study to examine the implementation and impact of new 2015 IPFQR program tobacco measures. This study may illustrate the potential effect that performance based penalties can have should facilities be required to do more than simply report on these tobacco measures. This study exemplifies the impact these new reporting measures can have when psychiatric facilities move beyond letter of the policy, to continually assess organizational performance and implement changes to improve treatment delivery.
authors.affiliation: University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Shane
authors.initials: S
authors.lastname: Carrillo
authors.affiliation: Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Niaman
authors.initials: N
authors.lastname: Nazir
authors.affiliation: Department of Organizational Improvement, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Eric
authors.initials: E
authors.lastname: Howser
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Lisa
authors.initials: L
authors.lastname: Shenkman
authors.affiliation: Department of Organizational Improvement, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Melinda
authors.initials: M
authors.lastname: Laxson
authors.affiliation: Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Taenisha S
authors.initials: TS
authors.lastname: Scheuermann
authors.affiliation: Department of Preventative Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS.
authors.forename: Kimber P
authors.initials: KP
authors.lastname: Richter
mesh_terms: D000328:Adult; D014487:Centers for Medicare and Medicaid Services, U.S.; D057286:Electronic Health Records; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology / Q000628:therapy; D016540:Smoking Cessation / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology