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Quality

NABH and our members are committed to the delivery of behavioral healthcare services that are responsive, accountable, and clinically effective prevention, treatment, and other needed services across the continuum of care for all age groups. Our advocacy efforts related to quality focus on initiatives to improve quality of care, as well as accurate, efficient and meaningful quality measurement and reporting.

NABH’s Quality Committee meets regularly to provide guidance to NABH staff on issues related to quality, including the quality reporting programs that require certain members to submit prescribed quality data to the Centers for Medicare and Medicaid Services.

NABH’s quality team is led by Sarah Wattenberg, LCSW-C, our Director of Quality and Addiction Services, and Rochelle Archuleta, EVP, who collectively advocate with policymakers on members’ priority issues pertaining to quality, including those covered in the materials outlined below.

Accreditation

Accreditation for behavioral healthcare organizations (including hospitals, residential treatment centers, and other organizational settings) is provided by several organizations, including:
The Joint Commission

NABH Representation on Joint Commission PTACs.
NABH holds seats on two key Professional and Technical Advisory Committees (PTACs) within The Joint Commission: the Hospital PTAC and the Behavioral Health PTAC.

NABH also participates in The Joint Commission’s Liaison Network.

NABH Leadership Role in HBIPS
NABH has also been playing a leadership role in efforts that have led to The Joint Commission’s core measures for inpatient psychiatric services. Learn more about the “Hospital-Based Inpatient Psychiatric Services” (HBIPS) core measures and the role of NABH.

Visit Joint Commission Website
CARF
CARF provides a variety of accreditation programs, including those for residential treatment services for youth.
Visit CARF Website
Council on Accreditation (COA)
Visit Council on Accreditation Website

HBIPS Core Measures

NABH is playing a leadership role in efforts now underway to collect and report data on core measures for inpatient psychiatric services.

The Hospital-Based Inpatient Psychiatric Services (HBIPS) core measure initiative is a major national leadership effort to improve quality, safety, and performance of hospital-based inpatient psychiatric services through the collaboration of hospitals, physicians, and consumers. It is part of The Joint Commission accreditation process.

HBIPS has created standardization of measures, data specifications, and definitions to help hospitals compare their performance within hospital-based psychiatric services to that of their peers. Get details at www.jointcommission.org/hbips.

  • About HBIPS
  • Learn more about the public-private partnership that helped to launch HBIPS. NABH and its partners (including the National Association of State Mental Health Program Directors, the NASMHPD Research Institute, Inc., in collaboration with the American Psychiatric Association and The Joint Commission) have played a leadership role in efforts to identify core measures for inpatient psychiatric services.

CMS IPF Quality Reporting

The Centers for Medicare & Medicaid Services (CMS) has approved six measures to meet the requirements of the Affordable Care Act’s (ACA) mandate for both psychiatric hospitals and psychiatric units to begin reporting inpatient quality measures. The ACA requires that, as of rate year 2014 (starting October 1, 2013), all facilities reimbursed under the inpatient psychiatric facility prospective payment system (IPF PPS) must report data on at least six measures to CMS for the purpose of public reporting, payment updates, and pilot pay-for-performance programs.

The measures CMS selected are six of the seven Hospital-Based Inpatient Psychiatric Services (HBIPS) core measures, which are already required of psychiatric hospitals by The Joint Commission (and available for use by psychiatric units to meet ORYX reporting requirements):

  • HBIPS-2 Hours of physical restraint use (patient safety)
  • HBIPS-3 Hours of seclusion use (patient safety)
  • HBIPS-4 Patients discharged on multiple antipsychotic medications (pharmacotherapy)
  • HBIPS-5 Patients discharged on multiple antipsychotic medications with appropriate justification (pharmacotherapy)
  • HBIPS-6 Post discharge continuing care plan created (care coordination) and
  • HBIPS-7 Post discharge continuing care plan transmitted to next level of care provider upon discharge (care coordination)

The CMS-approved measures respond to significant concerns voiced by NABH members and others in the behavioral health field about the importance of keeping measures focused and actionable and not layering-on additional – and potentially contradictory – measures and definitions. NABH was represented on the Technical Expert Panel convened by CMS to recommend measures for this ACA-mandated Inpatient Psychiatric Facilities Quality Reporting (IPFQR) Program. The association has been actively working for many years (through a public-private partnership) with The Joint Commission on core measure development and implementation.

NABH members have also been in the forefront of testing, refining, and successfully reporting these HBIPS measures to The Joint Commission over a significant period of time. With more than 450 hospitals using the measures – and reporting value in having the data available to help improve patient care – we believe that these measures represent the best thinking and experience of the field. The measures evolved from a consensus-driven, evidence-based process that has been supported by both the private and public sectors.

IMPORTANT RESOURCES:
www.QualityReportingCenter.com or www.qualitynet.org (for the latest updates from CMS)

8/22/16 — CMS final rule on inpatient PPS for acute-care hospitals (including sections on IPF Quality Reporting Program, observation status, and uncompensated care).  Also see 10.5.16 correction.

8/5/15 — CMS final rule: “Medicare Program; Inpatient Psychiatric Facilities Prospective Payment System-Update for FY16” (including IPF Quality Reporting measures on pages 46694-46719)

8/6/14 — CMS final rule:  “Medicare Program: IPF Prospective Payment System-Update for FY15.” See quality reporting requirements pages 45961-45980.

8/19/13 — CMS final rule on quality reporting requirements for inpatient psychiatric facilities (see pages 50887-50901).

National Quality Forum

The National Association for Behavioral Healthcare (NABH) was approved in 2010 as a member of the National Quality Forum (NQF) and serves on the Provider Council.

NQF-endorsed standards are the primary standards used to measure and report on the quality and efficiency of health care in the U.S., and the organization is recognized as a major force driving continuous improvement of healthcare quality.

NABH has worked with NQF through the approval process for the Hospital-Based Inpatient Psychiatric Services (HBIPS) core measures and will continue to work with NQF on future measure development. Membership allows NABH to have a more active role in identifying measurement priorities and representing the needs of behavioral healthcare organizations within the NQF process.

Other Quality Initiatives

Safety and the built environment for behavioral health facilities.

NABH works to provide members with resources and trainings that can assist facilities in their ongoing safety efforts.

See Training Materials on the NABH Resources page.

Design Guide for the Built Environment of Behavioral Health Facilities (latest edition).

NABH Training: MAXIMIZING SAFETY IN THE BEHAVIORAL HEALTH ENVIRONMENT OF CARE: An Update on the Latest Resources and Standards

NABH Training: BUILDING FOR TOMORROW: Creating a Patient-Centered Built Environment in Behavioral Healthcare Facilities

NABH Training: MANAGING RISK IN BEHAVIORAL HEALTH CARE

Public-Private Partnership

The National Association for Behavioral Healthcare (NABH) has been a leader in a unique public/private partnership since 2001, working to develop a set of clinical measures that providers could use to compare and continuously improve their performance across all inpatient hospital-level psychiatric treatment settings. The initiative began with staff and board level discussions among leaders of The National Association of State Mental Health Program Directors (NASMHPD), the NASMHPSD Research Institute (NRI, Inc.) and NABH.

Milestones in the public/private partnership include the following:

October 2001 

  • Representatives of NASMHPD, NRI, Inc., and NABH met to explore ways the organizations could collaborate to further their individual performance measurement goals.

October 2002    

  • The three organizations signed a Teeming Agreement, formalizing the relationship and agreeing to develop performance measures for public and private mental health system hospital services.

September 2003

  • The organizations led a “proof of concept” exploratory data collection effort, including 22 volunteer facilities, of both public- and private-sector hospitals. Analysis of the effort confirmed the organizations’ commitment to proceeding with the project and readiness to reach out to other partners.

March 2004                  

  • The Joint Commission and the American Psychiatric Association (APA) were asked to joined the collaborative and, with the founding partners, hosted a 24-member stakeholders meeting that included consumers, family members, providers, and researchers to provide input into the measurement framework.

April 2004 

  • The NABH, NASMHPD, NRI, Inc., (APA), and Joint Commission formally announced their intent to “identify a set of standardized, core measures for hospital-based, in-patient psychiatric services.”

May 2005                    

  • A Technical Advisory Panel (TAP), comprised of relevant stakeholders, was formed to oversee the core measurement development project.
  • Extensive measure identification specification work took place over almost two years.

January 2007                

  • More than 195 hospitals from both the public and private sectors volunteered to formally pilot test the proposed measures.

February 2008              

  • The TAP approved the measure set and recommended it for implementation.

October 2008

  • The Hospital Based Inpatient Psychiatric Services (HBIPS) core measure set became available for use by all psychiatric hospitals and psychiatric units in general hospitals.

December 2008  

  • The core measure set was submitted to the National Quality Forum (NQF) for endorsement. Measures two through seven were formally endorsed.

January 2011               

  • The Joint Commission made reporting of the HBIPS core measure set mandatory for all psychiatric hospitals.  HBIPS ccould be selected for reporting by psychiatric units in general hospitals.
  • The Centers for Medicare and Medicaid Services (CMS) appointed a Technical Expert Panel (TEP) to guide the development of quality measures for inpatient psychiatric hospitals and psychiatric units pursuant to Section 3401 subsection 10322 of the Patient Protection and Affordable Care Act (ACA). All collaborators in the original public/private partnership were appointed to the TEP.

September 2011           

  • Members of the TEP recommended HBIPS measures two through seven for inclusion in the CMS requirements for public reporting. CMS accepted the recommendation.

May 2012                     

  • CMS issued a proposed rule announcing their selection of HBIPS two through seven as the measures that would be required of all psychiatric hospitals (both public and private) and psychiatric units in general hospitals that are reimbursed under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS).

August 2012                 

  • CMS announced that, in order to avoid a 2% reduction in their payment update, IPF PPS hospitals would be required to report data on HBIPS two through seven. Data from admissions beginning October 1, 2012 (Rate Year 2013) would need to be used for payment purposes.

December 2012

  • All collaborators in the original public/private partnership continue to be appointed members of the TEP that will advise the Department of Health and Human Services (HHS) in their ongoing measurement development initiatives.

Policy Issues