Oregon QIO Strengthens Hospitals’ Ability to Report Quality Data

Reporting clinical quality data to the Centers for Medicare & Medicaid Services (CMS) is a challenging task with important consequences. When it’s done properly, patients receive information to make informed choices about health care providers, and hospitals qualify for increased Medicare funding. To ensure success, CMS directs QIOs to work with hospitals in their state or territory through the Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) initiative.

The data show the hospital’s level of performance on clinical measures of care that include acute myocardial infarction (AMI or heart attack); heart failure; pneumonia; prevention of infections; and prevention of post-surgical venous thromboembolism. These data are publicly reported on the CMS Hospital Compare website (http://www.hospitalcompare.hhs.gov) for use by health care consumers.

To ensure data accuracy and reliability, the CMS Clinical Data Abstraction Center (CDAC) randomly selects and reviews the medical records of five patients from each hospital. To pass validation, which is required to receive the full Medicare annual payment update, a hospital must receive an average score of at least 80 percent.

Education, Support and Encouragement

Acumentra Health, the QIO for Oregon, exemplifies the support that QIOs provide for successful data reporting. It works closely with hospitals to ensure they submit accurate, timely data to CMS. Because the issues identified by data validation are often unique, Acumentra Health staff work one-on-one with hospitals to provide focused technical assistance related to the CMS Abstraction and Reporting Tool and the specifications for clinical measures.

Publicity for hospitals that achieve 100 percent data validation is part of Acumentra Health’s RHQDAPU strategy. The main vehicle for recognition is the QIO’s e-newsletter, Q-News. Acumentra Health sends the bimonthly publication to approximately 1,400 readers, which include providers, quality improvement professionals and other health care stakeholders.

“By publishing the names of the facilities that have the highest validation rates, we aim to promote friendly competition among local hospitals,” said Kathy Phipps, R.N., CPUR, Acumentra Health quality improvement specialist. “With our hospital honor roll, we’ve created another incentive for quality reporting.”

Recognition of the honor roll hospitals began in January 2009, based on data from the first quarter of 2008. Although improvement in hospital data reporting cannot be entirely attributed to the QIO, Acumentra Health has observed growth in the number of hospitals achieving 100 percent accuracy and timeliness.

Keeping Up With New Requirements

Ongoing technical support and assistance from QIOs like Acumentra Health also helps hospitals meet new CMS requirements for reporting clinical quality data. On July 9, 2010, CMS updated policies and payment rates for general acute care hospitals that are paid for inpatient services under the Inpatient Prospective Payment System (IPPS). The proposed rule adds new RHQDAPU reporting measures, among other revisions. This story references requirements previous to the July 2010 release of new measures.