2. Data Collection Support Webinar MetaStar, Inc. August 15, 2007 Pam Clemens Candi Davis

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

4. Announcements Program Management Application ICD Population & Sampling Measures Designation

5. Announcements 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

6. Announcements Program Management Measures Designation Allows providers or their contracted vendor to designate the measures they will be submitting to the QIO Clinical Warehouse

7. Clarifications/Updates Quarter 4 – 2006 Validation Week 5 28 Hospitals Reported 10 PPS 18 CAH 5 Failures (all CAH) # 1 mismatch: PN – Chest X-ray Element

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

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

10. Clarifications/Updates 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 …

11. Clarifications/Updates 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

12. Clarifications/Updates Specification Manual v 2.3 Released in June For discharges October 1, 2007+ See Summary of AMI & HF Measure Changes See Summary of PN & SCIP Measure Changes

13. Clarifications/Updates 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.

14. Clarifications/Updates 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 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.

15. Hot Topics Inpatient Prospective Payment System Inpatient Prospective Payment System (IPPS) Final Rule FY 2008 released on August 2 nd

16. 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 removal SCIP-Cardiovascular 2: Surgical patients on beta blocker therapy prior to admission who received a beta blocker during the perioperative period

17. 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.”

18. 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.”

19. 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

20. 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

21. 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 points.”

22. Hot Topics Proposed quality measures for CY 2008 ER Transfer (AMI) – Aspirin at Arrival ER Transfer (AMI) – Median Time to Fibrinolysis 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

23. Hot Topics Proposed quality measures for CY 2008 (cont.) HF: ACE-I or ARB Therapy for LVSD Perioperative Care: Timing of Antibiotic prophylaxis Perioperative Care: Selection of Prophylactic Antibiotics Empiric Antibiotic for Community-Acquired Pneumonia Hemoglobin A1c Poor Control in Type 1 or 2 Diabetes Mellitus

24. 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 671.) “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.)

25. 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 measures. Comment period ends 09-14-07.

26. Hot Topics IPPS and OPPS See QNet home page for link to final IPPS rule Watch for final OPPS rule due out in November See IPPS and OPPS Fact Sheets on CMS website for details http://www.cms.hhs.gov/apps/media/fact_sheet s.asp

27. 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

28. 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 references

29. 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 arrival.”

30. 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.”

31. Submitted Questions Readmissions 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?”

32. Submitted Questions Readmissions 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.”

33. Questions/Feedback

34. Contact Information Contact Information: MetaStar, Inc. 2909 Landmark Place Madison, WI 53713 (608) 274-1940 or (800) 362-2320 www.metastar.com 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.