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January 14, 2009 8:45 – 9:30 a.m. EST

Voluntary Reporting of Hospital Outpatient Quality Data (Critical Access, IHS and Maryland Hospitals). January 14, 2009 8:45 – 9:30 a.m. EST. Agenda. Purpose/Vision Requirements Notice of Participation Reporting Hospital Outpatient Quality Data Reporting Program (HOP QDRP) Measures

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January 14, 2009 8:45 – 9:30 a.m. EST

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  1. Voluntary Reporting ofHospital Outpatient Quality Data(Critical Access, IHS and Maryland Hospitals) January 14, 2009 8:45 – 9:30 a.m. EST

  2. Agenda • Purpose/Vision • Requirements • Notice of Participation • Reporting Hospital Outpatient Quality Data Reporting Program (HOP QDRP) Measures • HOP QDRP Measures • Data Transmission • Population and Sampling • HOP QDRP FAQs

  3. Purpose Under the Tax Relief and Health Care Act of 2006, the Centers for Medicare and Medicaid Services (CMS) is required to implement a reporting program for data on the quality of hospital outpatient care using standardized measures.

  4. Vision CMS has established a separate reporting program with quality measures that are appropriate for measuring hospital outpatient quality of care. The reporting of quality measures for hospital outpatient services builds on previous efforts in the inpatient arena. Reporting is intended to encourage hospitals and clinicians to improve their quality of care and to empower consumers with this knowledge.

  5. Hospital Outpatient Quality Data Reporting Program (HOP QDRP) • Final CY 2009 OPPS Rule was published November 18, 2008; link is available at: www.qualitynet.org. • Hospital Outpatient Quality Data Reporting Program Support Contractor (HOP QDRP SC) is FMQAI. • Questions regarding the HOP QDRP: E-mail: hopqdrp@fmqai.com Call toll-free: 866-800-8756

  6. Initial Reporting Requirements • Submit completed HOP QDRP Notice of Participation Form by January 31, 2009. • Identify a QualityNet Security Administrator (SA). • Register with QualityNet Exchange. • Collect and submit data for the original seven measures as applicable, each quarter beginning with January 2009 services. (The four imaging measures will be generated from the hospital’s Medicare claims data in the claims warehouse.)

  7. Initial Reporting Requirements (cont.) • Submit medical records if chosen as one of the 800 hospitals to test validation sampling. (Validation requirements begin with January 2009 encounter dates and it is voluntary for CY 2009.) • Submit data by August 1, 2009. • A hospital with a new CMS Certified Number (CCN) needs to sign a Notice of Participation within 30 days and report data beginning with the quarter following receipt of the CCN.

  8. Voluntary Reporting Notice of Participation • Notice of Participation is to be completed (form or online) by the voluntary reporting hospitals no later than January 31, 2009. • Non-participating hospitals and vendors are not allowed to submit data into the OPPS Clinical Warehouse. • Voluntary reporting by critical access, Indian Health Services and Maryland hospitals begins with January 1, 2009, encounter dates.

  9. Notice of Participation (cont.) • By January 31, 2009: • Send the paper form with original signature to: HOP QDRP SC 5201 W. Kennedy Blvd, Suite 900 Tampa, FL 33609 OR

  10. Notice of Participation (cont.) • By January 31, 2009: • Complete the form online at My QualityNet according to the instructions. • Contact the HOP QDRP SC (FMQAI) at: 866-800-8756 if assistance is needed.

  11. Reporting HOP QDRP Measures • Voluntary reporting hospitals will not experience any financial impact for non-reporting of data. • Data is intended to be publicly reported. • Participating hospitals will have an opportunity to review the data prior to publication.

  12. HOP QDRP Measures The seven original measures: OP-1: Median Time to Fibrinolysis OP-2: Fibrinolytic Therapy Received Within 30 Minutes OP-3: Median Time to Transfer to Another Facility for Acute Coronary Intervention (Expands to OP-3a, OP-3b and OP-3c with 7/1/2009 encounters) OP-4: Aspirin at Arrival OP-5: Median Time to ECG OP-6: Antibiotic Timing OP-7: Antibiotic Selection

  13. HOP QDRP Measures (cont.) The four new measures will be calculated from data in the claims warehouse beginning with CY 2009 encounter dates: OP-8: MRI Lumbar Spine for Low Back Pain OP-9: Mammography Follow-up Rates OP-10: Abdominal CT – Use of Contrast OP-10a: CT - Abdomen – Use of contrast material excluding calculi of the kidneys, ureters and/or urinary tract OP-10b: CT - Abdomen – Use of contrast material for diagnosis of calculi in the kidneys, ureters and/or urinary tract OP-11: Thorax CT – Use of Contrast Material

  14. HOP QDRP Measures (cont.) Beginning with July 1, 2009 encounters, OP-3: Median Time to Transfer to Another Facility for Acute Coronary Intervention changes to: OP-3a: Median Time to Transfer to Another Facility for Acute Coronary Intervention – Overall Rate OP-3b: Median Time to Transfer to Another Facility for Acute Coronary Intervention – Reporting Measure OP-3c: Median Time to Transfer to Another Facility for Acute Coronary Intervention – Quality Improvement Measure

  15. Data Transmission • Hospitals must have a designated QualityNet SA, but two SAs provide the hospital more coverage and flexibility. • Data collection starts with 1st quarter (January-March) 2009 services.

  16. Data Transmission (cont.) • Data is due to the OPPS Clinical Warehouse by August 1, 2009. • Hospitals with five or less cases in a measure set are not required to submit that measure set for the reporting quarter.

  17. Data Transmission (cont.) • Send data to the OPPS Clinical Data Warehouse by a vendor (Vendor authorization must be completed online through My QualityNet). OR • Upload data to the OPPS Clinical Data Warehouse via CART. CART is available at www.qualitynet.org.

  18. HOP QDRP ReportingCalendar for CY 2009

  19. Population and Sampling Population and Sampling numbers are submitted to the OPPS Clinical Warehouse on the 15th day of month prior to the data reporting deadline.

  20. Populations Three populations are described in the Specifications Manual, version 2.0c: • AMI (OP-1, OP-2, OP-3, OP-4, and OP-5) – All AMIs transferred for coronary intervention and ICD-9-CM Codes found in Appendix A, Table 1.1. • Chest Pain (OP-4 and OP-5) – All Chest Pains with ICD-9-CM Codes found in Appendix A, Table 1.1a. • Surgery (OP-6 and OP-7) – All surgical patients billed as outpatients (not as ASC) and CPT codes found in Appendix A, Table 6.0 or Tables 6.1 through 6.7.

  21. Sampling • Sampling specifications will follow general requirements and guidance that are currently used in CMS’ Specifications Manual for Hospital Outpatient Quality Measures, version 2.0c. • As a general rule/policy of CMS, providers are encouraged to submit as many cases as possible up to the entire population of cases if reasonably feasible. • These basic data elements should be easily obtained from electronic files (e.g., from the billing department) and usually allow a computer-based sampling process.

  22. Sampling (cont.) The sample cases must be randomly selected to ensure that individual cases in the population have an equal chance of being selected and provide a good representation of the population. • Simple Random Sampling: selecting a sample size (n) from a population of size (N) in such a way that every case has the same chance of being selected. • Systematic Random Sampling: selecting every kth record from a population of size (N) in such a way that a sample size of n is obtained.

  23. Sampling(cont.) How many charts will hospitals need to abstract?* *Please see Specifications Manual, version 2.0c for detailed sample size information.

  24. Sampling(cont.) • Appendix A outlines the ICD-9-CM and CPT codes (including the E/M codes). • Guidelines can be found in the Sampling section of the Specifications Manual. • It is recommended that hospitals over-sample.

  25. Other Information • OPPS data reports mirror the IPPS data reports. • HOP QDRP SC will be posting national averages and benchmarks in the future. • For information and technical assistance, contact the HOP QDRP SC (FMQAI) at: hopqdrp@fmqai.com or 866-800-8756.

  26. HOP QDRP FAQs What are the requirements for sampling? • There is no requirement for stratified sampling by surgical type (OP-6 and OP-7). • The sample sizes will be monitored and may be changed in the future. • If you choose to sample, you will be asked to clearly indicate the sample size (n) and the population size (N) and the proportion of Medicare and non-Medicare patients in the sample. This information is reported to the OPPS Clinical Warehouse on the 15th day of the month prior to the data reporting deadline.

  27. HOP QDRP FAQs (cont.) Where can I find information? • Hospitals may download the HOD QDRP Specifications Manual at: www.qualitynet.org. When does voluntary HOP QDRP reporting start? • Participation agreement must be complete by COB January 31, 2009. • Data collection starts with January 2009 encounters and is due to OPPS Clinical Warehouse by August 1, 2009. • Population and Sampling data is due 7/15/2009.

  28. HOP QDRP FAQs (cont.) Will CART be supporting the Outpatient Quality Measures? • Yes, a CART module is available on www.qualitynet.org. In addition, most of the ORYX vendors have developed HOP QDRP tools.

  29. HOP QDRP FAQs (cont.) What specific “discharge codes” will apply to these measures? • Only “discharge codes” for ED AMI patients are used • 02, Discharge/transfer to short-term acute care hospital • 43, Discharge/transfer to Federal healthcare facility • 66, Discharge/transfer to CAH (Will be retired for 7/1/09 encounter dates)

  30. HOP QDRP FAQs (cont.) Does my ED have to follow any of the ED measures in the HOP QDRP if we do PCI and admits? • Any patient with AMI/chest pain who is discharged/transferred with a discharge code of 02 (discharged/transferred to a short term acute care hospital), 43 (discharged/transferred to a Federal hospital) or 66 (discharged/transferred to a CAH) will be included.

  31. Summary • Complete the participation agreement found on www.qualitynet.org. • Collect data on the seven initial outpatient measures begins with January 2009 services for AMI, Chest Pain and OP Surgery. CMS will collect claims data for the four imaging measures. • Sample appropriately following the guidelines found in the Specifications Manual, version 2.0c. • Report Population and Sampling data by July 15, 2009. • Transmit Q1 2009 data by August 1, 2009.

  32. HOP QDRP SC 5201 W. Kennedy Blvd, Suite 900 Tampa, FL 33609 866-800-8756 hopqdrp@fmqai.com FL20095NHODT5N0610985

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