At the Margins

The big PSI-90 change that could impact your P4P performance

by Eric Fontana and Kenna Hawes

You might be familiar with the PSI-90, a patient safety measure included in CMS's Inpatient Quality Reporting Program (IQR), Value-Based Purchasing Program (VBP), and Hospital-Acquired Conditions Program (HAC).

What you might not know is that the PSI-90 measure is being updated, and these modifications might impact your finances through the HAC and VBP programs. Read on for answers to members' top questions about these changes.

What is the PSI-90 update?

In brief, current PSI-90 v 5.0.1, which includes eight safety indicators, is being updated to PSI-90 v 6.0.1, which includes 10 safety indicators. Click here to see what each version of the PSI-90 metric contains.

Will my organization's PSI-90 performance change from v 5.0.1 to v 6.0.1?

According to the Agency for Healthcare Research and Quality (AHRQ), because the changes made to the modified PSI-90 are substantial, some hospitals' performance could change significantly from version 5.0.1 to version 6.0.1.

When will the modified PSI-90 be incorporated into IQR and HAC?

CMS is adopting the modified PSI-90 (v 6.0.1) in the IQR and HAC programs starting in the FY 2018 payment year. Since the PSI-90 measure composes all of HAC Domain 1, this change could shift your organization's HAC performance significantly when compared with past years'.

When will the new version be incorporated into VBP?

In the FY 2018 IPPS Proposed Rule, CMS proposed to introduce the modified version of the PSI-90 (v 6.0.1) starting in VBP payment year FY 2023. CMS also proposed removal of the PSI-90 from VBP from FY 2019-2022—more on that in a moment.

Why won't the new version be included in VBP immediately?

CMS cannot begin using the modified PSI-90 right away in VBP because VBP requires a three-year baseline period and a two-year performance period—five years of historical data in total —to assess hospitals' performance on the PSI-90. There is currently insufficient historical performance data for the modified PSI-90's baseline and performance period, so CMS cannot include the modified PSI-90 (v 6.0.1) in VBP yet. At the same time, CMS cannot continue to use PSI-90 v 5.0.1 in VBP because AHRQ is no longer supporting the older version of PSI-90. Since it can use neither version of the PSI-90 to determine providers' FY 2019 performance, CMS has proposed entirely removing the PSI-90 measure from VBP during the FY 2019-2022 period.

Does this mean that HAC and VBP are using different versions of the PSI-90 in FY 2018?

Yes. The FY 2018 HAC and VBP programs will be assessed based on two different versions of the PSI-90. The v 6.0.1 measure will be used in HAC and IQR, but the v 5.0.1 measure will still be used in VBP. If you're reviewing your hospital's performance on QualityNet, you might see a different PSI-90 value associated with your HAC/IQR performance vs. your VBP performance.

I use Advisory Board's VBP and HAC Performance Assessment. Does the modification of PSI-90 impact my organization's results in those tools?

Advisory Board's VBP Performance Assessment has already been updated to reflect the proposed removal of PSI-90 for the FY 2019 and FY 2020 program years. However, the HAC performance assessment does not yet reflect your organization's performance on the modified PSI-90 (v 6.0.1). CMS has not released PSI-90 v 6.0.1 data through Hospital Compare, so the HAC performance assessment currently incorporates your hospital's latest PSI-90 v 5.0.1 performance reported through Hospital Compare.

As soon as data for PSI-90 version 6.0.1 is available through Hospital Compare, we will incorporate it into our HAC performance estimates. The update might cause your hospital's projected HAC results to shift in the tool.

How did the PSI-90 measure change between v 5.0.1 and v 6.0.1?

The modified PSI-90 incorporates:

  • Updated patient population (2015 baseline)
  • Three new safety indicators  (PSI #9, PSI #10, and PSI #11)
  • Two re-specified safety indicators (PSI #12 and PSI #15)
  • Removal of one previous safety indicator (PSI #7)

In addition, the safety indicators included in the composite have been re-weighted to better reflect the relative importance and harm associated with each. In past versions of the PSI-90, accidental punctures and lacerations were the most highly weighted component indicators. Version 6.0.1 changes that—in the modified measure, the most heavily weighted metric is now post-operation sepsis.

Safety indicators in PSI-90 Version 5.0.1 vs. Version 6.0.1



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