Hospital Outpatient Quality Data Reporting Program

1
Hospital Outpatient Quality Data Reporting Program

• Initial Requirements for Hospital Outpatient
  Department Quality Measure Data Reporting

May 2008
2
Objectives

• Review the current scope of the Hospital
  Outpatient Quality Data Reporting Program (HOP
  QDRP)
• Identify the requirements for hospitals to
  successfully report data for the HOP QDRP

3
Presentation Outline

• Vision Background
• Program Overview Support
• Reporting Requirements
• Notice of Participation
• QualityNet Security Administrator
• HOP QDRP Measures
• CMS Specification Manual for Hospital Outpatient
  Quality Measures
• Population and Sampling
• Hospital Action Items
• Submission Deadlines Data Transmission
• Frequently Asked Questions

4
Vision

• The Centers for Medicare Medicaid Services
  (CMS) 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 inpatient
  efforts. Reporting is intended to encourage
  hospitals and clinicians to improve their quality
  of care and to empower consumers with this
  knowledge.

5
Background

• Tax Relief and Health Care Act of 2006
• OPPS Final Rule published 11/27/07
• (available at www.qualitynet.org)
• CMS must implement a data reporting program for
  hospital outpatient data to be used toward CY
  2009 payments

6
Program Overview

• Hospital Outpatient Quality Data Reporting
  Program (HOP QDRP)
• Standardized measures for the quality of care to
  patients receiving outpatient services
• Voluntary participation
• Publicly reported data
• Opportunity to review data prior to publication
• National averages and benchmarks
• Non-reporting results in 2.0 reduction in the
  hospitals OPPS annual payment update (APU) for
  CY 2009 payments

7
Program Support

• HOP QDRP Support Contractor FMQAI
• Provide technical assistance to hospitals for
  data reporting
• Provide education to hospitals and their vendors
  nationally

8
Initial Reporting Requirements

• Submit HOP QDRP Notice of Participation Form by
  01/31/2008.
• Identify and register a QualityNet Security
  Administrator in My QualityNet.
• Collect data for 7 outpatient measures, as
  applicable, each quarter beginning with
  04/01/2008 encounters using the CMS
  Specifications Manual.
• Submit Population and Sampling data for Q2 2008
  encounters by 10/15/2008 via My QualityNet.
• Transmit Q2 2008 data to the OPPS Clinical
  Warehouse by 11/01/2008.

9
Participation Withdrawal

• To withdraw, a facility must submit the HOP QDRP
  Notice of Participation form with the Do Not
  Agree box checked.
• The OPPS Clinical Warehouse will not accept data
  from non-participating hospitals or vendors.

10
QNet Security Administrator

• Facilitates the registration process for other
  users at the organization.
• Hospitals submitting data via My QualityNet are
  required to designate a Security Administrator.
• Existing SAs had outpatient roles added to their
  accounts.
• New SAs assignments will follow description in
  QNet Administrator packet available from the
  QualityNet Help Desk at qnetsupport_at_ifmc.sdps.org.

11
HOP QDRP 7 Measures (OP-1 to 7) 2 topic areas
(ED and Perioperative Care)

• 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
• OP-4 Aspirin at Arrival
• OP-5 Median Time to ECG
• OP-6 Antibiotic Timing
• OP-7 Antibiotic Selection

12
Specifications Manual

• The Specification Manual for Hospital Outpatient
  Department Quality Measures was developed by CMS
  to provide a uniform set of quality measures to
  be implemented in hospital outpatient settings.
• The primary purpose of these measures is to
  promote high quality care for patients receiving
  services in hospital outpatient settings.

13
Outpatient Populations

• All Medicare non-Medicare patients who share a
  common set of specified, administratively derived
  data elements.
• Three distinct hospital outpatient sample
  populations
• AMI OP-1, 2, 3, 4, 5
• Chest Pain OP-4, 5
• Surgery OP-6, 7
• Each outpatient population is defined in the
  Measure Information section of the Specifications
  Manual v1.0a.

14
Outpatient Populations

• 1. AMI (OP-1, OP-2, OP-3, OP-4, and OP-5)
• ED patient gt18 yrs of age
• Transferred (discharge status 02, 43, or
  66) for coronary intervention
• ICD-9-CM Code found in Appendix A, Table 1.1 in
  the Specifications Manual v1.0a
• 2. Chest Pain (OP-4 and OP-5)
• ED patient gt18 yrs of age
• Transferred (discharge status 02, 43, or
  66) for coronary intervention
• ICD-9-CM Codes found in Appendix A, Table 1.1a in
  the Specifications Manual v1.0a

15
Outpatient Populations

• 3. Surgery (OP-6 and OP-7)
• Surgical patients gt 18 yrs of age
• Seen in hospital-based outpatient surgery center
  (billed as outpatients)
• Does not include Ambulatory Surgery Centers
• CPT code found in Appendix A, Table 6.0 of the
  Specifications Manual v1.0a
• Laparoscopic Cholecystectomy
• Only patients gt70 yrs of age CPT code found in
  Appendix A, table 6.4b of the Specifications
  Manual v1.0a

16
Sampling

• Sampling specifications will follow general
  requirements and guidelines that are currently
  used in CMSs Specifications Manual for Hospital
  Outpatient Quality Measures v1.0a.
• CMS encourages providers to submit as many cases
  as possible up to the entire population of cases
  if feasible.
• The basic data elements should be obtainable from
  electronic files (e.g., billing department) that
  usually allow a computer-based sampling process.
• CMS is aware outpatient data systems may exist
  separately from other hospital data systems.

17
Sampling

• The sample cases must be selected in a manner
  that ensures individual cases in the population
  have an equal chance of being selected, thus,
  providing a representative sample of the
  population.
• Simple random sampling select a sample size (n)
  from a population of size (N) in such a way that
  every case has an equal chance of being selected.
  
• Systematic random sampling select every kth
  record from a population of size (N) in such a
  way that a sample size of n is obtained.

18
Sampling
How many charts will hospitals need to abstract?
See Specifications Manual for complete table
19
Sampling

• Appendix A of the Specifications Manual outlines
  the ICD-9-CM (Table 1.1 and 1.1a) and CPT codes
  (Table 6.0), including the E/M codes (Table 1.0).
• Sampling guidelines can be found in the
  Population Sampling section of the
  Specifications Manual.
• Sampling requirements apply to each distinct
  measure set population.
• It is recommended that hospitals overestimate
  their sample sizes to account for exclusions.

20
Sampling

• There is no requirement for stratified sampling
  by surgical type (OP-6 and OP-7).
• The sample size requirements will be monitored
  and may be changed in the future.
• If hospitals choose to sample, they 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.

21
Hospital Action Items

• Determine if active QualityNet Security
  Administrator available internally.
• Download HOP QDRP Specifications Manual (version
  1.0a) from www.qualitynet.org.
• Determine vendor or CMS Abstraction Reporting
  Tool (CART) usage.
• If using CART, download CART - Outpatient
  (version 1.0) from www.qualitynet.org.

22
Hospital Action Items

• Review paper abstraction tools published on
  www.qualitynet.org for possible internal use.
• Work with other hospital departments to determine
  patient population.
• Comment on OPPS proposed rule for CY 2009
  scheduled for release August 2008.

23
Submission Deadlines
24
Data Transmission
25
FAQs

• Where can I find information?
• QualityNet (www.qualitynet.org) is the online
  location for accessing information about the HOP
  QDRP.
• Where can I get the Specifications Manual?
• Hospitals can download the HOD QDRP
  Specifications Manual at www.qualitynet.org.
• When does the HOP QDRP start?
• Data collection started with 04/01/2008
  encounters. Data for encounters 04/01/2008
  06/30/2008 must be submitted to the OPPS Clinical
  Warehouse by 11/01/2008.

26
FAQs

• What specific discharge codes will apply to
  these measures?
• Discharge codes only apply to the ED AMI/CP
  measures
• 02, Discharge/transfer to short term acute care
  hospital
• 43, Discharge/transfer to federal hospital
• 66, Discharge/transfer to critical access
  hospital
• Will CART support the Outpatient Quality
  Measures?
• Yes, there is a CART module available for
  downloading at www.qualitynet.org. In addition,
  most of the ORYX vendors have notified TJC of
  their support of HOP QDRP.

27
FAQs

• Does my ED need to follow any of the ED measures
  in the HOP QDRP if we perform PCI and admit the
  patients?
• Admitted patients are considered inpatients and
  excluded from the HOP QDRP measure population.
• However, any outpatient with AMI/chest pain that
  is discharged/transferred with a discharge code
  of 02, 43, or 66 will be included.

28
FAQs

• Are Critical Access Hospitals (CAH) included?
• CAHs are not included under the statute.
• On January 31, 2008 CMS committed to allow CAHs
  to voluntarily submit data.
• More information will be forthcoming regarding
  this process.

29
Thank You

• HOP QDRP SC
• 5201 W. Kennedy Blvd., Suite 900
• Tampa, FL 33609
• 1-866-800-8756
• hopqdrp_at_fmqai.com

This material was prepared by FMQAI under
contract with the Centers for Medicare Medicaid
Services (CMS). The contents presented do not
necessarily reflect CMS policy.
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