Understanding Changes in Medicare’s Hospital IQR Program

Understanding Changes in Medicare’s Hospital IQR Program
The Future of Patient-Centered Care Starts Now

By Debbie Ahl, Senior Advisor to MyDirectives

Starting in 2025, hospitals that participate in Medicare’s Hospital Inpatient Quality Reporting (IQR) Program will face a transformative shift in how they deliver care, driven by new Medicare reimbursement requirements under the program. These changes aim to ensure that patient-centered care is not just a philosophy but a measurable practice. From assessing social vulnerabilities to documenting patient health goals, hospitals must adopt comprehensive protocols to prioritize “what matters most” to patients. MyDirectives is here to help healthcare providers and payers navigate this new era with tools that ease compliance, enhance patient engagement, and improve care outcomes.

New Medicare Reimbursement Requirements.
The updated Hospital IQR Program introduces measures that focus on aligning care with patients’ needs and priorities. Hospitals that participate in the program will be required to document protocols addressing key areas such as:

• Eliciting patient health care goals
• Responsibly managing medications
• Implementing frailty screening and intervention, including for cognition and mobility
• Assessing social vulnerability (e.g. social isolation, caregiver stress, elder abuse)
• Designating age-friendly leadership

These measures aren’t just regulatory hurdles—they represent a systemic push toward improving care quality and outcomes for older adults. Hospitals that that choose not to participate in the IQR program or otherwise fail to comply face reductions in their annual Medicare payment update.

What Matters Most
Intuitively, hospitals, health systems and payers know it makes sense to place patients and members at the very center of healthcare diagnostic and treatment plans.   What was once just a buzzword – “patient-centric care” – has evolved into a guiding principle for hospitals, health systems, and payers.

Patients may not always understand the complexities of medical procedures, but they do know what they value most in their quality of life. By focusing on “What Matters Most,” providers can better align diagnostic and treatment plans with individual preferences and needs.

Easing the Burden on Providers
MyDirectives simplifies this crucial task with MyDirectives for Clinicians, a mobile-optimized SaaS platform. This solution provides structured prompts and content-specific questions to guide providers in capturing an individual’s healthcare goals and preferences.

The platform is seamlessly integrated with most major electronic health record (EHR) systems – such as Oracle Health, Epic, PointClickCare, and MEDITECH – which further reduces administrative burdens. Integration with athenahealth and other systems is also underway. Additionally, the platform supports obtaining witness signatures in MyDirectives for Clinicians, as well as the ability to print notary forms, have it notarized, and upload the completed forms, ensuring legal compliance where needed.

In alliance with the National POLST Collaborative, MyDirectives routinely incorporates state portable medical order forms, such as POLST, MOLST, or MOST, as well as state out-of-hospital DNR forms, to provide comprehensive support for advance care planning (ACP).

Engaging Health Plans to Reach Members Early
Proactive engagement is essential. We’ve also made it easier for health plans to engage with their members and offer them the opportunity to complete an advance directive, well before critical moments of care. Through single sign-on (SSO) via the health plan’s portal, members can easily create and update their advance directives, and initial accounts can be auto-populated with member information from the portal.

The platform supports:

• Creating and completing advance care planning documents
• Uploads of video recordings or existing paper documents, including Five Wishes and Veterans Administration Form 10-0137
• Member engagement tools
• Tailored executive reports and transactional detail

These capabilities align with programs like Value-Based Insurance Design (VBID), helping health plans meet innovative payment model requirements while improving member experiences.

Completing the Ecosystem
In order to optimize the ability for these ACPs to be accessed when they are needed most across multiple care transitions, our interoperability with multiple EHRs is critical to ensuring access to patient advance directives at multiple points of care. But it doesn’t stop there, because access to advance care planning documents when they are needed most is critical. That’s why MyDirectives has connected with national data systems including eHealthExchange, Carequality and CommonWell, as well as with numerous state and regional health information exchanges (HIEs). We have also established relationships with EMS software providers to offer MyDirectives for Clinicians Query & Retrieve software to any first responder at no cost. This works to dramatically increase the likelihood that a person’s preferences of care can be known, anytime, anywhere.  

At the Heart of It All: The A|D Vault Exchange
Central to MyDirectives’ ecosystem is the A|D Vault Exchange, the only national registry and repository in existence. Drawing its name from “advance directives exchange,” the A|D Vault Exchange is a secure, cloud-based repository that is HITRUST certified. All document uploads, digital ACPs and videos are securely stored in the A|D Vault Exchange for access by the people who need it when it matters most.

Conclusion
As we look ahead to the future of healthcare, MyDirectives continues to innovate and collaborate, making advance care planning seamless, secure, and accessible. As the 2025 Medicare requirements approach, hospitals, health systems, and payers can count on MyDirectives to help them meet these new standards while keeping patients at the center of care.

To learn more, contact us at solutions@mydirectives.com, or call (469) 238-2858, option 2.