HSAG was selected by FMQAI, the Florida Medicare quality improvement organization (QIO), to serve as the HOP QDRP subcontractor. HSAG has been involved in the HOP QDRP since the inception of the program, which began in September 2007. The HOP QDRP was established in response to the Medicare Improvements and Extension Act under Division B of Title I of the Tax Relief and Health Care Act (MIEA-TRHCA) of 2006. The MIEA-TRHCA resulted in changes to the outpatient prospective payment system and required CMS to establish a quality data reporting program for hospitals to submit standardized measures for the assessment of hospital outpatient care. Hospitals that fail to report receive a two percent reduction of their annual payment rate update (APU). The first reporting period began with April 1, 2008 patient encounter dates. The following quality measures are currently collected under the HOP QDRP:
Acute Myocardial Infarction:
- Median time to fibrinolysis
- Fibrinolytic therapy received within 30 minutes
- Median time to transfer to another facility for acute coronary intervention
- Asprin at arrival
- Median time to ECG
- Antibiotic timing
- Median time to ECG
- Antibiotic timing
- Antibiotic selection
- Magnetic resonance imaging (MRI) lumbar spine for low back pain
- Mammography follow-up rates
- Abdomen computed tomography (CT)—Use of contrast material
- Thorax CT—Use of contrast material
HSAG provides FMQAI and CMS with a broad array of expertise ranging from epidemiology and health care management to bioinformatics and data analysis. HSAG performs the following tasks as a subcontractor for this program:
- Coordination of measures and data element specifications—HSAG participates in collaborative team meetings with CMS and CMS contractors to discuss the development of the HOP QDRP Specifications Manual. Specifically, HSAG is responsible for the maintenance of the population and sampling and data transmission specifications. HSAG also reviews and provides feedback on all proposed changes to data element and measure specifications.
- CMS Abstraction and Reporting Tool (CART) development and support—HSAG is responsible for the development and maintenance of CART paper tools to assist hospitals with data element abstraction. Additionally, HSAG reviews updates to the electronic version of CART and provides feedback as necessary.
- Validation support of hospital outpatient department-generated data—The validation process for the HOP QDRP is currently being developed and finalized; however, HSAG will assist FMQAI and CMS once a final validation process is employed.
- Data management—HSAG performs ad hoc data requests for the HOP QDRP. Currently, HSAG generates over 3,000 individualized quarterly reports for HOP QDRP-participating hospitals that depict the Medicare claims case count for each measure set. Additionally, HSAG generates internal reports for CMS and FMQAI to identify under-submitting hospitals, hospitals with missing population and sampling data, and/or non-submitting hospitals. CMS and FMQAI use these reports to ensure that HOP QDRP-participating hospitals meet program requirements.
- National partnership and external communications support—HSAG participates in all vendor and provider educational teleconferences and provides support to FMQAI as needed. Additionally, HSAG provides editorial support for external communications.
- Data support for public reporting—CMS intends to publicly report HOP QDRP-reported. When this occurs, HSAG will assist FMQAI and CMS with the publishing of these data.
- Ambulatory surgical center (ASC) environmental scan—In Contract Year 1, HSAG performed an environmental scan of the ASC setting to establish the effectiveness, efficiency, and appropriateness of implementing an HOP QDRP-like program in ASCs. Currently, there is not a quality data reporting program specific to ASCs. If such a program is developed, CMS will take into consideration the recommendations provided by HSAG in the environmental scan.
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