Administrative Memos

200402

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 21, 2004
SUBJECT: QualityNet HPMP Data Distribution
IPRO CONTACTS:

Kathy Terry, Ph.D., Senior Director, Data Analysis, Medicare/Federal Health Care Assessment, Ext. 364

Recently the Centers for Medicare & Medicaid Services (CMS) announced approval for IPRO to share the CMS Hospital Payment Monitoring Program (HPMP) target areas and data contained within these target areas with New York State (NYS) acute care hospitals. These target areas focus on discharges at risk for payment errors due to incorrect DRG coding and/or potential unnecessary admissions. Focus areas include one-day stays, readmissions, and clusters of DRGs including Pneumonia, Septicemia, Respiratory Distress, Fractures, Esophagitis, Nutritional and Metabolic Disorders, Chest Pain, Heart Failure, and Stroke.

At this time, IPRO is releasing an administrative data tool (prepared by the HPMP Support QIO and approved by CMS) to assist each hospital in identifying their potential outlier status for each of the targeted areas. This tool, called PEPPER for Program for Evaluating Payment Patterns Electronic Report, provides hospital-specific Medicare discharge data for fiscal years (FYs) 2000, 2001, 2002 and 2003 to date. These data provide detail on your hospitals standing in relation to other NYS acute care hospitals, your dollars received for each year for target areas, your length of stay, and more. These data, presented in tabular and graphic formats, may be manipulated through the Excel tool in which they are distributed. A Users Guide is attached (Attachment B) and will also accompany this data distribution. Statewide conference calls and web training will be provided in February.

As you are likely aware, in 1998 the Office of the Inspector General (OIG) released "The Office of Inspector General's Compliance Program Guidance for Hospitals" which encourages hospitals to develop and implement a compliance program. One aspect of a compliance program involves ensuring that charges for Medicare services are correctly documented and billed. To this end, hospitals should be conducting regular audits to ensure that charts document the need for the setting of care including the treatment and that the bills for services are correct. These data disseminated by IPRO may be used to guide auditing efforts and should be utilized by management staff as needed.

At this time, target area hospital-specific data has been disseminated through QualityNet Exchange. QualityNet Exchange is a web portal that provides secure, interactive applications for the exchange and input of privacy data between healthcare providers and the Quality Improvement Organization (QIO) responsible for their state. The purpose of QualityNet Exchange is to improve the quality of care for Medicare beneficiaries through increased efficiencies in information exchange. QualityNet Exchange accomplishes this by providing secure, real-time communications and data exchange between healthcare providers, IPRO, and End Stage Renal Disease (ESRD) Networks. Currently hospitals are using QualityNet Exchange to submit quality indicator data on Heart Failure, Acute Myocardial Infarction, Pneumonia and Surgical Infection Prevention.

Your hospital QualityNet Administrator currently has the ability to download this data. Alternatively, you may also register for QualityNet exchange to download this data. Download instructions and materials needed for registration for QualityNet exchange should you wish to register and/or find that your hospital is not currently registered and is therefore unable to retrieve this data. As part of the instructions, you will find the name of your QualityNet Administrator if your hospital is currently registered, or a statement of the need to register if your hospital is not registered.

Distributed with this memorandum is a Program for Evaluating Payment Patterns Electronic Report (PEPPER) User's Guide, which provides instruction for how to best use your data once downloaded. This Guide has also been provided in electronic format with your data in QualityNet Exchange along with a fax-back form requesting your input for training days and times in February 2004. Please provide feedback as soon as possible so that we may choose training dates that are most advantageous to the hospitals.

IPRO believes the use of the QualityNet portal for data exchange will be a useful tool for IPRO and the hospitals and look forward to exchanging case review data in addition to quality improvement data and education materials through this medium. We recognize that there will be some efforts on all of our parts to ensuring all hospitals have access to their data; IPRO is ready to assist hospitals in this effort as needed. Should you have any questions or comments about this memorandum and/or the data please contact Dr. Kathy Terry, Sr. Director, Medicare Federal Health Care Assessment at 516-326-7767, extension 364. Questions related to QualityNet Exchange registration issues should be directed to Jonathan Miller, Assistant Director, IS at 516-326-7767, extension 665.