08-15-07 DCS Presentation

Document Sample
08-15-07 DCS Presentation Powered By Docstoc
					Data Collection Support

MetaStar, Inc.
August 15, 2007
Pam Clemens
Candi Davis

Carol Ferguson Resignation
RHQDAPU Form Due August 15th
Program Management Applications

Program Management Application
  ICD Population & Sampling
  Measures Designation
           Program Management

ICD Population & Sampling
  Allows providers or their contracted vendor to
  enter their sampling frequency, total population
  counts, and sample sizes for each quarter
          Program Management

Measures Designation
  Allows providers or their contracted vendor to
  designate the measures they will be submitting
  to the QIO Clinical Warehouse
      Quarter 4 – 2006 Validation

Week 5
28 Hospitals Reported
  10 PPS
  18 CAH
5 Failures (all CAH)
  # 1 mismatch: PN – Chest X-ray Element
          Validation Rate Graphs

Validation Rate Graphs
  Updated through 3Q06
  Will be mailed to public reporting contact
  Review cover letter for next steps
           MedQIC Updates

AMI/HF Contraindication Pocket Card
Heart Care Discharge Instructions Fact
Heart Care Reperfusion Performance
Measures for AMI Fact Sheet
           MedQIC Updates

FACT SHEETS for Diagnostic Uncertainty,
Identified Pneumonia Pathogen, and Chest
X-ray for Discharges 4/1/07+
Core Measures Quick Reference Guide –
April 1, 2007
Much more …
          Quest Answers Revised
CMS has released a list of QUEST answers that
have been revised for May and June 2007
If it is your practice to utilize printed copies of
QUEST FAQs, make sure abstractors are aware of
these revised answers
The most frequently asked about data element for
both May and June was PN: Chest X-ray
     Specification Manual v 2.3
Released in June
For discharges October 1, 2007+
See Summary of AMI & HF Measure
See Summary of PN & SCIP Measure
Data Abstraction Training Resources
Mock medical records (fictitious charts) have been
developed for use by hospitals and Medicare
Quality Improvement Organizations (QIOs) in
training data abstractors.
Staff can use the gold standard records to practice
abstracting data for submission to the QIO
Clinical Warehouse.
Three charts are provided for each clinical topic.
Data Abstraction Training Resources
Abstractions of the mock medical records for each
topic are provided as “answer keys.”
These abstracted cases were created using CART
paper tools
The abstracted cases correlate with the CMS and
Joint Commission abstraction guidelines effective
with 04-01-07 discharges.
              Hot Topics
Inpatient Prospective Payment System
Inpatient Prospective Payment System
(IPPS) Final Rule FY 2008 released on
August 2nd
              Hot Topics
Inpatient Prospective Payment System
New measures added to bring total to 27
Expanded measure set for FY 2009
  Pneumonia 30-day Mortality (Medicare patients)
  SCIP-Inf-4: Cardiac surgery patients with controlled
  6AM postoperative serum glucose
  SCIP-Inf-6: Surgery patients with appropriate hair
  SCIP-Cardiovascular 2: Surgical patients on beta
  blocker therapy prior to admission who received a beta
  blocker during the perioperative period
              Hot Topics
Inpatient Prospective Payment System
Expanded measure set for FY 2009
  “These measures have been endorsed, or are currently
  under endorsement review by the NQF and will be
  added to the measure set, contingent on their receiving
  NQF endorsement by publication of the OPPS CY 2008
  final rule in November 2007.”
  “Data collection for these measures for purposes of
  RHQDAPU will begin in CY 2008.”
              Hot Topics
Inpatient Prospective Payment System
Data Submission:
  “CMS is requiring hospitals to submit
  aggregate population and sample size counts for
  Medicare and non-Medicare discharges for the
  four topic areas on a quarterly basis.”
              Hot Topics
Inpatient Prospective Payment System
Hospital-Acquired Conditions
  Present On Admission (POA)
Public display identifying hospitals that
share a common Medicare Provider Number
Value-Based Purchasing FY 2009
              Hot Topics
Outpatient Prospective Payment System
 Outpatient Prospective Payment System
 (OPPS) Final Rule CY 2008 is due out in
 November 2007
 Effective with calendar year beginning
 January 1, 2008
              Hot Topics
Outpatient Prospective Payment System
 “In this rule, CMS is proposing new
 measures that are specific to hospital
 outpatient services.”
 “Hospitals that fail to report data for these
 outpatient-specific measures would incur a
 reduction in their annual payment update
 factor in CY 2009 by 2.0 percentage
              Hot Topics
 Proposed quality measures for CY 2008
ER Transfer (AMI) – Aspirin at Arrival
ER Transfer (AMI) – Median Time to
ER Transfer (AMI) – Fibrinolytic Therapy
Received Within 30 minutes of Arrival
ER Transfer (AMI) – Median Time to ECG
ER Transfer (AMI) – Median Time to
Transfer for Primary PCI
                 Hot Topics
Proposed quality measures for CY 2008 (cont.)
 HF: ACE-I or ARB Therapy for LVSD
 Perioperative Care: Timing of Antibiotic
 Perioperative Care: Selection of Prophylactic
 Empiric Antibiotic for Community-Acquired
 Hemoglobin A1c Poor Control in Type 1 or 2
 Diabetes Mellitus
              Hot Topics
Outpatient Prospective Payment System
 “To receive full OPPS payment rate update in CY
 2009, the hospital must pass our validation
 requirement of a minimum of 80% reliability,
 based on our chart-audit validation process, for the
 January 2008 discharges.” (Reference: CMS-1392-P page
 “Our intent is to make this information public in
 CY 2009 by posting it on the CMS Web site.”
 (Reference CMS-1392-P page 674.)
              Hot Topics
Outpatient Prospective Payment System
 “Therefore, we are seeking public comment on the
 following 30 additional measures, which have
 been identified as hospital outpatient-appropriate
 measures and are under consideration for inclusion
 in the HOP QDRP measure set, for CY 2010 or
 subsequent calendar years:”
   See CMS-1392-P pages 660-664 for list of proposed
 Comment period ends 09-14-07.
              Hot Topics
            IPPS and OPPS
See QNet home page for link to final IPPS
Watch for final OPPS rule due out in
See IPPS and OPPS Fact Sheets on CMS
website for details
         Topic of the Day
      PN: Chest X-ray Element
Many validation mismatches have occurred
  Due to abstractor error
  Recommend review abstraction guidelines
  Pay attention to ANY x-ray interpretation
  found in narrative documentation such as
  discharge summary
         Topic of the Day
      PN: Identified Pathogens

Need NOT be a final report if you have a
specified organism
  Gram positive cocci on a gram stain is NOT an
  identified/ specified organism
  Most often you will NOT have an identified
  pathogen within 24 hours of arrival
See table for further guidance and Quest
          Submitted Questions
           IV Beta Blockers
Quest # 89815
  Question: “For 4/1/07 discharges, please
  explain rationale of why within the
  „contraindication to beta blocker on arrival‟ the
  statement „physician documentation of
  hold/discontinuation of IV beta blocker‟ is
  included among the exception for clearly
  implied reasons for prescribing beta blocker on
          Submitted Questions
           IV Beta Blockers
Quest # 89815
  Answer: “For 4/1/07+ discharges: This change
  is intended to reduce the number of false
  exclusions that result due to an order to hold or
  discontinue IV beta blockers. Orders for IV
  beta blockers are commonplace, and a patient is
  not expected to continue on chronic IV beta
  blockers – They will eventually need to be
  discontinued as the patient is transitioned to
  oral beta blockers.”
          Submitted Questions
Quest # 55302 April 2006
  Question: “…for hospital quality measure
  reporting purposes, should the clinically related
  same day readmissions be reported as one
  encounter (i.e. admit date of first admission and
  discharge date of second admission) as required
  by CMS for claims submission?”
          Submitted Questions
Quest # 55302
  Answer: “CMS is aware of this issue and at
  this time, for abstraction purposes, we have
  been given the direction that these readmissions
  should be treated as two different episodes of
  care, even though for billing it is one episode of
  care. If one of the records is pulled for
  validation, the provider should only send the
  documentation for the dates of the record that
  was pulled.”
Contact Information:

MetaStar, Inc.
2909 Landmark Place
Madison, WI 53713

(608) 274-1940 or (800) 362-2320

This material was prepared by MetaStar under contract with the Centers for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS
policy. 8SOW-WI-INP-07-104.

Shared By: