The Centers for Medicare & Medicaid Services (CMS) is proposing to risk adjust stroke mortality measures for stroke severity – a positive step but one the association feels does not go far enough. Stroke measures should also account for sociodemographic status (SDS), which can complicate care for vulnerable patients, America’s Essential Hospitals said in comments Aug. 26 to CMS.

CMS selected the National Institutes of Health Stroke Scale (NIHSS) as the stroke severity assessment to be incorporated in risk adjustment of the measures in development. The NIHSS is a 15-item neurologic examination, administered at the bedside, that evaluates the effect of acute ischemic stroke on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.

One approach to such risk adjustment would involve claims-only data and the NIHSS, while a second approach would use a hybrid of claims and electronic health record (EHR) data and the NIHSS.

America’s Essential Hospitals supports the inclusion of risk-adjustment for stroke severity, but urged CMS to ensure measures are adjusted for patient sociodemographic status to accurately reflect the stroke patient population treated at essential hospitals. Additionally, the association urged CMS to provide robust guidance and time for hospitals to become familiar with the collection and reporting of this measure and use of the NIHSS.

Please contact Maryellen Guinan, Esq., policy analyst, at mguinan@essentialhospitals.org or 202.495.3354 with any questions.