The Centers for Medicare & Medicaid Services (CMS) Acute Care Hospital Fiscal Year (FY) 2018 Quality Improvement Program Measures

Size: px
Start display at page:

Download "The Centers for Medicare & Medicaid Services (CMS) Acute Care Hospital Fiscal Year (FY) 2018 Quality Improvement Program Measures"

Transcription

1 ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) CMS Measures Fiscal Year 2018 The Centers for Medicare & Medicaid Services (CMS) Acute Care Fiscal Year (FY) 2018 Improvement Measures IQR IQR VBP VBP - HACRP HACRP (HRRP) HRRP HRRP Chart-Abstracted Measures ED-1 ED-2 Median Time from ED Arrival to ED Departure for Admitted ED Patients Admit Decision Time to ED Departure Time for Admitted Patients No No No No No No No No IMM-2 Influenza Immunization Note : The IMM-2 measure is collected for all 4 quarters; however, only discharges included in 1st and 4th quarters will be included in the measure calculation. The IMM-2 measure is reported by flu season on CMS's Compare site Flu Season: December Flu Season: December 2017 No No No No PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation 0469 December 2017 No No No Sepsis Severe Sepsis and Septic Shock: Management Bundle (Composite Measure) 0500 No No No No STK-04 Thrombolytic Therapy 0437 VTE-5 VTE-6 NHSN Measures Venous Thromboembolism Discharge Instructions Incidence of Potentially Preventable Venous Thromboembolism No No No No No No No No No No No No CLABSI CAUTI Central Line-Associated Bloodstream Infection (CLABSI) Outcome Measure Catheter-associated Urinary Tract Infection (CAUTI) Outcome Measure December 2017 No December 2017 No December 2017 No December 2017 No Colon and Abdominal Hysterectomy SSI American College of Surgeons Centers for Disease Control and Prevention (ACS-CDC) Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure Colon Procedures Hysterectomy Procedures 0753 December 2017 No December 2017 No MRSA Bacteremia Facility-wide -onset Methicillin-resistant Staphylococcus aureus (MRSA) Bacteremia Outcome Measure 1716 December 2017 No December 2017 No CDI Facility-wide -onset Clostridium difficile Infection (CDI) Outcome Measure 1717 December 2017 No December 2017 No HCP Influenza Vaccination Coverage Among Healthcare Personnel 0431 October 1, March 31, December No No No No Patient Survey HCAHPS Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey + 3 Item Care Transition Measure (CTM-3) December 31, December 2017 No No No January 1

2 ID Me asure Name NQF # - (HRRP) CMS Measures Fiscal Year 2018 IQR IQR VBP VBP - HACRP HACRP (HRRP) HRRP HRRP Claims-Based Measures MORT-30-AMI MORT-30-HF MORT-30-PN 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Acute Myocardial Infarction (AMI) ization 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Heart Failure (HF) ization 30-Day, All-Cause, Risk-Standardized Mortality Rate Following Pneumonia ization October 1, June 30, 2012 October 1, October 1, June 30, 2012 October 1, October 1, June 30, 2012 October 1, December 2017 No No No December 2017 No No No December 2017 No No No MORT-30-COPD 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Chronic Obstructive Pulmonary Disease (COPD) ization 1893 No No No No STK Mortality Stroke 30-day Mortality Rate No No No No CABG Mortality 30-Day, All-Cause, Risk-Standardized Mortality Rate (RSMR) Following Coronary Artery Bypass Graft (CABG) Surgery 2558 No No No No READM-30-AMI 30-Day All-Cause Risk-Standardized Readmission Rate (RSRR) Following Acute Myocardial Infarction (AMI) ization 0505 No No No READM-30-HF 30-Day, All-Cause, Risk-Standardized Readmission Rate (RSRR) Following Heart Failure (HF) ization 0330 No No No READM-30-PN 30-Day, All-Cause, Risk-Standardized Readmission Rate (RSRR) Following Pneumonia ization 0506 No No No READM-30-THA/TKA READM-30-HWR -Level 30-Day, All-Cause Risk- Standardized Readmission Rate (RSRR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) -Wide All-Cause Unplanned Readmission Measure (HWR) July 1, No No No No No No No COPD READMIT 30-Day, All-Cause, Risk-Standardized Readmission Rate (RSRR) Following Chronic Obstructive Pulmonary Disease (COPD) ization 1891 No No No STK READMIT 30-Day Risk Standardized Readmission Rate Following Stroke ization No No No No CABG READMIT 30-Day, All-Cause, Unplanned, Risk- Standardized Readmission Rate (RSRR) Following Coronary Artery Bypass Graft (CABG) Surgery 2515 No No No Hip/Knee Complications PSI 4 (PSI/NSI) -Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Death among Surgical s with Serious, Treatable Complications April 1, March 31, July 1, No No No No No No No No January 2

3 ID Me asure Name NQF # - (HRRP) ID Me asure Name NQF # - (HRRP) CMS Measures Fiscal Year 2018 PSI-90 MSPB ID Measure Name NQF # Patient Safety for Selected Indicators (Composite Measure) Payment-Standardized Medicare Spending Per Beneficiary (MSPB) IQR July 1, December 31, IQR VBP July 1, June 30, 2012 July 1, VBP - December 2017 No HACRP July 1, HACRP (HRRP) HRRP HRRP December 2017 No December 2017 No No No AMI Payment -Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care for Acute Myocardial Infarction (AMI) 2431 No No No No HF Payment PN Payment -Level, Risk-Standardized Payment Associated with a 30-Day Episode-of-Care For Heart Failure (HF) -Level, Risk-Standardized Payment Associated with a 30-day Episode-of-Care For Pneumonia No No No No No No No No THA/TKA Payment Level, Risk Standardized Payment Associated with an Episode-of-Care for Primary Elective Total Hip Arthroplasty and/or Total Knee Arthroplasty April 1, March 31, No No No No Kidney/UTI Payment Cellulitis Payment GI Payment Kidney/Urinary Tract Infection Clinical Episode- Based Payment Measure Cellulitis Clinical Episode-Based Payment Measure Gastrointestinal Hemorrhage Clinical Episode- Based Payment Measure No No No Dry Run Only Dry Run Only Dry Run Only No No No No No No No No No No No No AMI Excess Days Excess Days in Acute Care after ization for Acute Myocardial Infarction No No No No HF Excess Days Structural Excess Days in Acute Care after ization for Heart Failure Patient Safety Culture Survey on Patient Safety Culture Registry for Nursing Sensitive Care Registry for General Surgery Participation in a Systematic Clinical Database Registry for Nursing Sensitive Participation in a Systematic Clinical Database Registry for General Surgery Safe Surgery Checklist Safe Surgery Check List Use No No No No December 2017 No No No No December 2017 No No No No December 2017 No No No No December 2017 No No No No AMI-2 Aspirin Prescribed at Discharge for AMI 0142 * Submit for 1 Calendar Year (CY) Quarter (Q3 or Q4) AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Arrival 0164 * AMI-8a Primary PCI Received Within 90 Minutes of Arrival 0163 * January 3

4 CMS Measures Fiscal Year 2018 IQR IQR VBP VBP - HACRP HACRP (HRRP) HRRP HRRP AMI-10 Statin Prescribed at Discharge * CAC-3 Home Management Plan of Care Document Given to Patient/Caregiver * ED-1 Median Time from ED Arrival to ED Departure for Admitted ED Patients 0495 * ED-2 Admit Decision Time to ED Departure Time for Admitted Patients 0497 * ED-3 Median Time from ED Arrival to ED Departure for Discharged ED Patients 0496 No No ** EHDI-1a Hearing Screening Prior to Discharge 1354 * HTN Healthy Term Newborn 0716 * PC-01 Elective Delivery (Collected in aggregate) 0469 * PC-05 Exclusive Breast Milk Feeding and the Subset Measure PC-05a Exclusive Breast Milk Feeding Considering Mother s Choice 0480 * PN-6 Initial Antibiotic Selection for Community- Pneumonia (CAP) in Immunocompetent Patients 0147 * January 4

5 CMS Measures Fiscal Year 2018 IQR IQR VBP VBP - HACRP HACRP (HRRP) HRRP HRRP SCIP-Inf-1a Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision 0527 * SCIP-Inf-2a Prophylactic Antibiotic Selection for Surgical Patients 0528 * SCIP-Inf-9 Urinary catheter Removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with Day of Surgery Being Day Zero * STK-02 Discharged on Antithrombotic Therapy 0435 * STK-03 Anticoagulation Therapy for Atrial Fibrillation/Flutter 0436 * STK-04 Thrombolytic Therapy 0437 * STK-05 Antithrombotic Therapy by the End of Day Two 0438 * STK-06 Discharged on Statin Medication 0439 * STK-08 Stroke Education * STK-10 Assessed for Rehabilitation 0441 * January 5

6 CMS Measures Fiscal Year 2018 IQR IQR VBP VBP - HACRP HACRP (HRRP) HRRP HRRP VTE-1 Venous Thromboembolism Prophylaxis 0371 * VTE-2 Intensive Care Unit Venous Thromboembolism Prophylaxis 0372 * VTE-3 Venous Thromboembolism Patients with Anticoagulation Overlap Therapy 0373 * VTE-4 Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or Nomogram * VTE-5 Venous Thromboembolism Discharge Instructions * VTE-6 Incidence of Potentially Preventable Venous Thromboembolism * Footnotes (*) A hospital may choose to submit this measure as one of the four ecqms required for the IQR. (**) A hospital may choose to submit this measure as: one of the 16 ecqms required for the for submission through the CMS Registration and Attestation system or one of the four required for the for submission through the Net Secure Portal. Updates to Document Date of Update Summary of Update 01/27/ Updated time of the -Wide All-Cause Unplanned Readmission Measure (HWR) (READM-30-HWR) in the to display July 1, 2015-June 30, in place of. January 6

Hospital Inpatient Quality Reporting (IQR) Program

Hospital Inpatient Quality Reporting (IQR) Program Clinical Process Measures Program Changes for Fiscal Year 2014 Beginning with January 1, 2012 discharges; hospitals will begin data collection and submission for 4 new measures. Hospitals will not be required

More information

FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar

FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar FY 2015 Inpatient PPS Proposed Rule Quality Provisions Webinar June 2, 2014 AAMC Staff: Scott Wetzel, swetzel@aamc.org Mary Wheatley, mwheatley@aamc.org The AAMC has moved. New Address: 655 K Street, Washington

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES & 42 CFR 412 45 CFR

DEPARTMENT OF HEALTH AND HUMAN SERVICES & 42 CFR 412 45 CFR 1 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Part 412 Office of the Secretary 45 CFR Part 170[CMS-1632-P] RIN-0938-AS41 Medicare Program; Hospital Inpatient

More information

Time for a Cool Change Measure and Compare

Time for a Cool Change Measure and Compare Time for a Cool Change Measure and BRENDA BARTKOWSKI, CMA, CCA, BS HPA M ANAGER, C LINICAL D ATA A BSTRACTION About Amphion Dedicated core measure staff Experienced leadership in healthcare technology

More information

Value Based Purchasing (VBP) Awareness Brief. FY 2018 Value Based Purchasing Program Domain Weighting

Value Based Purchasing (VBP) Awareness Brief. FY 2018 Value Based Purchasing Program Domain Weighting Value Based Purchasing (VBP) Awareness Brief This Awareness Brief provides a high level summary understanding of value based purchasing. The Hospital Value Based Purchasing (VBP) Program adjusts hospitals

More information

CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014

CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 CLINICAL QUALITY MEASURES FINALIZED FOR ELIGIBLE HOSPITALS AND CRITICAL ACCESS HOSPITALS BEGINNING WITH FY 2014 e 55 0495 2 Emergency Department (ED)- 1 Emergency Department Throughput Median time from

More information

FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015

FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015 FY 2016 Inpatient PPS Proposed Rule Quality Issues May 21, 2015 AAMC Staff: Scott Wetzel, swetzel@aamc.org Mary Wheatley, mwheatley@aamc.org Agenda Summary of key quality and payment IPPS provisions Cross-cutting

More information

National Provider Call: Hospital Value-Based Purchasing (VBP) Program

National Provider Call: Hospital Value-Based Purchasing (VBP) Program National Provider Call: Hospital Value-Based Purchasing (VBP) Program Fiscal Year 2016 Overview for Beneficiaries, Providers and Stakeholders Cindy Tourison, MSHI Lead, Hospital Inpatient Quality Reporting

More information

Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY 2014 IPPS Rule

Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY 2014 IPPS Rule Hospital Inpatient Quality Reporting Program: Part 1 of 4: A Detailed Review of the Final CMS FY IPPS Rule - 1 - Welcome and Introductions Vicky Mahn DiNicola RN, MS, CPHQ VP Research and Market Insights

More information

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Bethany Wheeler Hospital VBP Program Support Contract Lead HSAG February 17, 2015 2 p.m. ET Purpose This event will provide an

More information

Value Based Purchasing Hospital Program FY 13 Final Rule

Value Based Purchasing Hospital Program FY 13 Final Rule SPECIAL REPORT: Value Based Purchasing Hospital Program FY 13 Final Rule August 7, 2012 Washington Strategic Consulting 1825 Eye Street, NW, Suite #600 Washington, DC 20006 www.wscdc.com www.wscblog.com

More information

Three-Star Composite Rating Method

Three-Star Composite Rating Method Three-Star Composite Rating Method CheckPoint uses three-star composite ratings to enable consumers to more quickly and easily interpret information about hospital quality measures. Composite ratings combine

More information

Hospital Compare Star Ratings. Public Comment Report #1: Measure Selection for Hospital Star Ratings

Hospital Compare Star Ratings. Public Comment Report #1: Measure Selection for Hospital Star Ratings Hospital Compare Star Ratings Public Comment Report #1: Measure Selection for Hospital Star Ratings Prepared by: Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (YNHHSC/CORE)

More information

June 10, 2015. Dear Mr. Slavitt:

June 10, 2015. Dear Mr. Slavitt: 1275 K Street, NW, Suite 1000 Washington, DC 20005-4006 Phone: 202/789-1890 Fax: 202/789-1899 apicinfo@apic.org www.apic.org June 10, 2015 Andrew M. Slavitt Acting Administrator Centers for Medicare &

More information

A Review of the Hospital Performance Data Expansion Policy and Outpatient Measures Data Requirements

A Review of the Hospital Performance Data Expansion Policy and Outpatient Measures Data Requirements A Review of the Hospital Performance Data Expansion Policy and Outpatient Measures Data Requirements Theressa Lee, Director, Center for Quality Measurement and Reporting Presented to the HSCRC Performance

More information

Table of Contents. Current and Proposed CMS Quality Measures for Reporting in 2016 through 2022 Revised 8/8/2016

Table of Contents. Current and Proposed CMS Quality Measures for Reporting in 2016 through 2022 Revised 8/8/2016 Table of Contents Current and Proposed CMS Quality Measures Inpatient Measures Collected and Submitted by Hospital AMI/ED/IMM/Pneumonia/Sepsis/Stroke Page 2 Surgical Care Improvement/VTE Page 3 Perinatal

More information

Quality and Business Intelligence in Healthcare

Quality and Business Intelligence in Healthcare Quality and Business Intelligence in Healthcare John Neider Siemens Healthcare Solutions Agenda Overview of Quality and Financial Impact. What is the Hospital Impact? Where is Quality Headed? How can Finance

More information

Hospital Value-based Purchasing Specifications 2016 Updated August 2015

Hospital Value-based Purchasing Specifications 2016 Updated August 2015 Description Methodology Measurement Period Allowable Exclusions Total Performance Score Individual measures CMS incentive program for PPS hospitals. The purpose is to achieve value by tying payment to

More information

EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies

EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies EHR Meaningful Use 2014 (Stage 1 & 2) DR Reporting Strategies International MUSE Conference 2013 Educational Session: #1179 Date: Friday May 31 at 3:30 pm Presenter: Glen D Abate Session Agenda CMS EHR

More information

Evidence Based Practice to. Value Based Purchasing. Barb Rogness BSN MS Building Bridges May 2013

Evidence Based Practice to. Value Based Purchasing. Barb Rogness BSN MS Building Bridges May 2013 Evidence Based Practice to Value Based Purchasing Barb Rogness BSN MS Building Bridges May 2013 Why this topic? Value based Purchasing is here and not going away. It will grow by leaps and bounds. The

More information

OVERVIEW OF THE FY 2016 IPPS FINAL RULE

OVERVIEW OF THE FY 2016 IPPS FINAL RULE OVERVIEW OF THE FY 2016 IPPS FINAL RULE SUMMARY OF CALCULATION ELEMENTS Published in the Federal Register August 17 th Comments due September 29 th Rule to take effect October 1 st INDEX TO FFY 2016 CHANGES

More information

Relevant Quality Measures for Critical Access Hospitals

Relevant Quality Measures for Critical Access Hospitals Policy Brief #5 January 0 Relevant Quality Measures for Critical Access Hospitals Michelle Casey MS, Ira Moscovice PhD, Jill Klingner RN, PhD, Shailendra Prasad MD, MPH University of Minnesota Rural Health

More information

Clinical Quality Measures. for 2014

Clinical Quality Measures. for 2014 Clinical Quality Measures for 2014 Mission of OFMQHIT To advance the implementation and use of vital health information technology to improve healthcare quality, efficiency and safety by assisting physician

More information

Medical Assistance EHR Incentive Program MAPIR Application. 2014 EH Stage 2 Screen Shots

Medical Assistance EHR Incentive Program MAPIR Application. 2014 EH Stage 2 Screen Shots Medical Assistance HIT Initiative Medical Assistance EHR Provider Incentive Program Eligible Hospital Provider Manual v.3.1 Medical Assistance EHR Incentive Program MAPIR Application 2014 EH Stage 2 Screen

More information

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012

Value-Based Purchasing Program Overview. Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Value-Based Purchasing Program Overview Maida Soghikian, MD Grand Rounds Scripps Green Hospital November 28, 2012 Presentation Overview Background and Introduction Inpatient Quality Reporting Program Value-Based

More information

CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM

CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM For Immediate Release: Friday, January 07, 2011 Contact: CMS Office of Public Affairs 202-690-6145 MEDICARE PROPOSES NEW HOSPITAL VALUE-BASED PURCHASING PROGRAM OVERVIEW: Today the Centers for Medicare

More information

Chapter Seven Value-based Purchasing

Chapter Seven Value-based Purchasing Chapter Seven Value-based Purchasing Value-based purchasing (VBP) is a pay-for-performance program that affects a significant and growing percentage of Medicare reimbursement for medical providers. It

More information

Meaningful Use (MU) Education

Meaningful Use (MU) Education Meaningful Use (MU) Education The 2014 MU training program has been developed to ensure high quality patient outcomes in conjunction with meeting CMS regulatory requirements. The new charting and ordering

More information

convey the clinical quality measure's title, number, owner/developer and contact

convey the clinical quality measure's title, number, owner/developer and contact CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical

More information

Hospital Compare Downloadable Database Data Dictionary

Hospital Compare Downloadable Database Data Dictionary System Requirements Specification Hospital Compare Downloadable Database Data Dictionary Centers for Medicare & Medicaid Services https://data.medicare.gov/data/hospital-compare of Contents Introduction...

More information

Troubleshooting Audio

Troubleshooting Audio Welcome! Audio for this event is available via ReadyTalk Internet Streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines

More information

Troubleshooting Audio

Troubleshooting Audio Welcome! Audio for this event is available via ReadyTalk Internet Streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. Limited dial-in lines

More information

Telligen Quality Innovation Network Quality Improvement Organization. We See Where the Health Care Reform Bus is Taking Us How Do We Get On?

Telligen Quality Innovation Network Quality Improvement Organization. We See Where the Health Care Reform Bus is Taking Us How Do We Get On? Telligen Quality Innovation Network Quality Improvement Organization We See Where the Health Care Reform Bus is Taking Us How Do We Get On? Telligen QIN QIO Telligen: Quality Innovation Network-Quality

More information

July 2015 Dry Run. Methodology of Overall Hospital Quality Star Ratings

July 2015 Dry Run. Methodology of Overall Hospital Quality Star Ratings Hospital Quality Star Ratings on Hospital Compare July 2015 Dry Run Methodology of Overall Hospital Quality Star Ratings Prepared by: Yale New Haven Health Services Corporation/Center for Outcomes Research

More information

Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services. July 13, 2015

Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services. July 13, 2015 Current Medicare Fee-for-Service Pay-for-Performance Initiatives for Hospital and Physician Services July 13, 2015 Broad Overview of Payment Policy Direction Current State Future State Current mandatory

More information

Value-Based Purchasing

Value-Based Purchasing Emerging Topics in Healthcare Reform Value-Based Purchasing Janssen Pharmaceuticals, Inc. Value-Based Purchasing The Patient Protection and Affordable Care Act (ACA) established the Hospital Value-Based

More information

International Hospital Inpatient Quality Measures

International Hospital Inpatient Quality Measures I-Acute Myocardial Infarction (I-AMI) I-AMI-1 Aspirin at Arrival Aspirin received within 24 hours of arrival to the hospital for patients having an acute myocardial infarction (AMI). I-AMI-2 Aspirin Prescribed

More information

Hospital Report Card Reporting Manual

Hospital Report Card Reporting Manual Vermont Department of Health Hospital Report Card Reporting Manual (REVISED May, 206) Issued: May 206 206 HOSPITAL REPORT CARD REPORTING MANUAL TABLE OF CONTENTS INTRODUCTION 3 REPORTING SPECIFICATIONS

More information

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P)

Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and payment changes (CMS-1632-P) Date 2015-04-17 Title Fiscal Year 2016 proposed Inpatient and Long-term Care Hospital policy and

More information

America s Hospitals: Improving Quality and Safety

America s Hospitals: Improving Quality and Safety America s Hospitals: Improving Quality and Safety The Joint Commission s Annual Report 2014 Top Performer on Key Quality Measures America s Hospitals: Improving Quality and Safety The Joint Commission

More information

This proposed rule clarifies and makes updates to details regarding this program that were finalized in

This proposed rule clarifies and makes updates to details regarding this program that were finalized in 2014 Ambulatory Surgery Center (ASC) and Outpatient Prospective Payment System (OPPS) A Summary of the Quality Provisions of the Proposed Rule Overview On July 8, 2013, the Centers for Medicare and Medicaid

More information

Clinical Quality Measures for 2014 And Meaningful Use Updates. Lindsey Wiley, MHA HIT Manager

Clinical Quality Measures for 2014 And Meaningful Use Updates. Lindsey Wiley, MHA HIT Manager Clinical Quality Measures for 2014 And Meaningful Use Updates Lindsey Wiley, MHA HIT Manager An Important Reminder For audio, you must use your phone: Step 1: Call (866) 906-0123. Step 2: Enter code 2071585#.

More information

MU Stage 2: Domains and Details. Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics.

MU Stage 2: Domains and Details. Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics. MU Stage 2: Domains and Details Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014 anita@healthmetrics.org Welcome to the Webinar If you cannot hear any sound or if you

More information

America s Hospitals: Improving Quality and Safety

America s Hospitals: Improving Quality and Safety America s Hospitals: Improving Quality and Safety The Joint Commission s Annual Report 2015 Top Performer on Key Quality Measures America s Hospitals: Improving Quality and Safety The Joint Commission

More information

Preventing Readmissions

Preventing Readmissions Emerging Topics in Healthcare Reform Preventing Readmissions Janssen Pharmaceuticals, Inc. Preventing Readmissions The Patient Protection and Affordable Care Act (ACA) contains several provisions intended

More information

Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule. May 26, 2015 // 12:00 P.M. 1:00 P.M. EST

Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule. May 26, 2015 // 12:00 P.M. 1:00 P.M. EST Advancing Risk Capability in 2015: MACRA and 2016 Medicare Proposed Rule May 26, 2015 // 12:00 P.M. 1:00 P.M. EST Center For Industry Transformation The DHG Healthcare Center for Industry Transformation

More information

Meaningful Use: Moving to Stage 2 and the Leadership Required to Achieve Success

Meaningful Use: Moving to Stage 2 and the Leadership Required to Achieve Success Meaningful Use: Moving to Stage 2 and the Leadership Required to Achieve Success Liz Johnson, MS, FCHIME, FHIMSS, CPHIMS, RN-BC VP of Applied Clinical Informatics, Chief Clinical Informaticist Tenet Healthcare

More information

Medicare Hospital Quality Chartbook

Medicare Hospital Quality Chartbook Medicare Hospital Quality Chartbook Performance Report on Outcome Measures SEPTEMBER 2014 AMI COPD Heart Failure Pneumonia Stroke 0.5 0.4 Density 0.3 0.1 30 0.0 25 0 10 20 30 30 day Risk standardized Mortality

More information

NY Medicaid. EHR Incentive Program

NY Medicaid. EHR Incentive Program Eligible Hospitals Participation Year 2-3 (MU1) Webinar www.emedny.org/meipass 1 Background Original Legislation The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of

More information

Interventional Cardiology Peripheral Interventions Rhythm Management

Interventional Cardiology Peripheral Interventions Rhythm Management FY2016 Hospital Inpatient Rule (IPPS) Interventional Cardiology Peripheral Interventions Rhythm Management On April 17, 2015 the Centers for Medicare and Medicaid Services (CMS) released the Hospital Inpatient

More information

Value Based Purchasing and You

Value Based Purchasing and You Value Based Purchasing and You David Gourley, RRT, MHA, FAARC Director of Clinical Services and Risk Management Millennium Respiratory Services Whippany, New Jersey Value Based Purchasing and You Overview

More information

How do the Measures Relate to My Health?

How do the Measures Relate to My Health? How do the Measures Relate to My Health? As a consumer, the more you know about your health and the care that you are receiving, the more you can participate in important decisions with your doctor and

More information

AnMed Health Disparities Dashboard

AnMed Health Disparities Dashboard AnMed Health Quick Facts 588 Bed Acute Care System Level II Trauma Center Emergency Department visits: 112,329 Admissions: 23,489 Active Medical Staff: 455 Employees: 3,511 Source : CY2013 Setting the

More information

emeasures Transitions

emeasures Transitions WHITE PAPER 1010100010101010101010101001000011001 10101000101101101000100000101010010000101011001001010110 0101000101101010001010101010101010100100001010 0101000101101010001011011010001000001010100100

More information

West Virginia Electronic Health Records (EHR) Provider Incentive Program (PIP) For Eligible Hospitals Meaningful Use Attestation Guide

West Virginia Electronic Health Records (EHR) Provider Incentive Program (PIP) For Eligible Hospitals Meaningful Use Attestation Guide West Virginia Electronic Health Record Provider Incentive Program MEANINGFUL USE - Hospital West Virginia Electronic Health Records (EHR) Provider Incentive Program (PIP) For Eligible Hospitals Guide Date

More information

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Presented by Susan Haviland, BSN RN Senior Consult, Santa Rosa Consulting Meaningful Use Quality Measures Centers for Medicare and Medicaid Services

More information

June 22, 2012. Dear Administrator Tavenner:

June 22, 2012. Dear Administrator Tavenner: Submitted Electronically Marilyn Tavenner Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System Fiscal Year 2017

Medicare Inpatient Rehabilitation Facility Prospective Payment System Fiscal Year 2017 Proposed Rule Summary Medicare Inpatient Rehabilitation Facility Prospective Payment System Fiscal Year 2017 May 2016 1 P a g e Table of Contents Overview and Resources... 2 Inpatient Rehabilitation Facility

More information

Inpatient Quality Reporting Program

Inpatient Quality Reporting Program 2015 IPPS Final Rule Webinar AM Questions and Answers Transcript Moderator: Deb Price, PhD, MEd, MSPH Educational Coordinator, Inpatient Quality Reporting (IQR) Program Speakers: Barbara Choo, RN, FNP,

More information

HEN 2.0 Kickoff. Jessica Rowden, Clinical Quality Improvement Manager August 19, 2015

HEN 2.0 Kickoff. Jessica Rowden, Clinical Quality Improvement Manager August 19, 2015 HEN 2.0 Kickoff Jessica Rowden, Clinical Quality Improvement Manager August 19, 2015 1 Agenda Current HEN 2.0 contract status Potential HEN 2.0 strategy Aligning MHA strategies Potential contract deliverables

More information

Overview and Legal Context

Overview and Legal Context Impact of ACOs on Physician/Provider Membership Decisions 0 Overview and Legal Context Michael R. Callahan Katten Muchin Rosenman LLP Vice Chair, Medical Staff Credentialing and Peer Review Practice Group

More information

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE

HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE HAI LEADERSHIP PARTNERING FOR ACCOUNTABLE CARE Cepheid s Government Affairs Department Advocating for Patient Access to Molecular Diagnostics in the Era of Healthcare Reform A TEAM APPROACH Legislative

More information

National Provider Trends & Strategic Considerations Around Value Based Purchasing

National Provider Trends & Strategic Considerations Around Value Based Purchasing National Provider Trends & Strategic Considerations Around Value Based Purchasing Melinda S. Hancock, FHFMA,CPA Partner, DHG Healthcare 2015-16 Chair, HFMA Southern California HFMA August 2015 Objectives

More information

Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich

Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich Medicare s Hospital Value-Based Purchasing Program, a New Era in Medicare Reimbursement by Daniel J. Hettich Medicare s new hospital inpatient value-based purchasing ( VBP ) program, mandated by the Affordable

More information

Medicare Long-Term Care Hospital Prospective Payment System

Medicare Long-Term Care Hospital Prospective Payment System Medicare Long-Term Care Hospital Prospective Payment System May 5, 2015 Payment Rule Brief PROPOSED RULE Program Year: FFY 2016 Overview, Resources, and Comment Submission On May 17, the Centers for Medicare

More information

Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary. http://www.cms.gov/ehrincentiveprograms/

Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary. http://www.cms.gov/ehrincentiveprograms/ Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary 2010 What are the Requirements of Stage 1 Meaningful Use? Basic Overview of Stage 1 Meaningful Use: Reporting period

More information

2015 Hospital Measures

2015 Hospital Measures 2015 Hospital Measures Vicki Tang Olson, Stratis Health David Hesse, Minnesota Department of Health Statewide Quality Reporting and Measurement System (SQRMS) Annual Update January 14, 2015 Objectives

More information

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner:

June 2, 2014. RE: File Code CMS-1608-P. Dear Ms. Tavenner: . June 2, 2014 Marilyn Tavenner Centers for Medicare & Medicaid Services Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington, DC RE: File Code CMS-1608-P Dear Ms. Tavenner: The

More information

NHS outcomes framework and CCG outcomes indicators: Data availability table

NHS outcomes framework and CCG outcomes indicators: Data availability table NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential

More information

Hospital Quality Program Evaluation & Scoring Methodology. December 20, 2013

Hospital Quality Program Evaluation & Scoring Methodology. December 20, 2013 Hospital Quality Program Evaluation & Scoring Methodology December 20, 2013 DISCLAIMER The following content represents the Evaluation and Scoring Approach Appendix of the 2014 Hospital Quality Program.

More information

Medicare Long-Term Care Hospital Prospective Payment System

Medicare Long-Term Care Hospital Prospective Payment System Medicare Long-Term Care Hospital Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2015 Overview, Resources, and Comment Submission On May 15, the Centers for Medicare and Medicaid

More information

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

what value-based purchasing means to your hospital

what value-based purchasing means to your hospital Paul Shoemaker what value-based purchasing means to your hospital CMS has devised an intricate way to measure a hospital s quality of care to determine whether the hospital qualifies for incentive payments

More information

Patient Experience. The Cleveland Clinic Journey. American Medical Group Association Orlando, Florida March 14, 2013

Patient Experience. The Cleveland Clinic Journey. American Medical Group Association Orlando, Florida March 14, 2013 Patient Experience The Cleveland Clinic Journey American Medical Group Association Orlando, Florida March 14, 2013 James Merlino, MD Chief Experience Officer Overview How did Cleveland Clinic change their

More information

Value Based Purchasing: Combining Cost and Quality

Value Based Purchasing: Combining Cost and Quality Value Based Purchasing: Combining Cost and Quality Michael T. Rapp, MD, JD, FACEP Director, Quality Measurement and Health Assessment Group Office of Clinical Standards & Quality Centers for Medicare &

More information

In the postacute continuum space, long-term acute care hospitals (LTCH)

In the postacute continuum space, long-term acute care hospitals (LTCH) Postacute CDI: An Introduction to Long-Term Acute Care Hospitals WHITE PAPER Summary: This white paper provides an overview of long-term acute care hospitals and how they differ from short-term acute care

More information

Medicare Hospital Quality Chartbook

Medicare Hospital Quality Chartbook Medicare Hospital Quality Chartbook Performance Report on Outcome Measures SEPTEMBER 2013 PREPARED BY Yale New Haven Health Services Corporation Center for Outcomes Research and Evaluation List of Contributors

More information

CMS Hospital Inpatient Quality Reporting Program

CMS Hospital Inpatient Quality Reporting Program Handbook II: CMS Hospital Inpatient Quality Reporting Program This training handbook is a resource for the Hospital Inpatient Quality Reporting (IQR) Program for the Centers for Medicare & Medicaid Services

More information

September 2013. Hospital Performance Measures Instruction Manual

September 2013. Hospital Performance Measures Instruction Manual September 2013 Hospital Performance Measures Instruction Manual Version 7.0 Ohio Department of Health (ODH) Division of Quality Assurance Revised: 09/03/2013 1 Contents Background... 4 General Data Reporting

More information

The Medicare Readmissions Reduction Program

The Medicare Readmissions Reduction Program The Medicare Readmissions Reduction Program Impact on Rural Hospitals Harvey Licht Varela Consulting Group August, 2013 CMS Readmissions Reduction Program: Authority Section 3025 of the Patient Protection

More information

Chapter Three Accountable Care Organizations

Chapter Three Accountable Care Organizations Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

More information

Interventional Cardiology Peripheral Interventions Rhythm Management

Interventional Cardiology Peripheral Interventions Rhythm Management FY2016 Hospital Inpatient Final Rule (IPPS) Interventional Cardiology Peripheral Interventions Rhythm Management On July 31, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Final

More information

Value-Based Purchasing An Opportunity for Clinical Nurse Leaders

Value-Based Purchasing An Opportunity for Clinical Nurse Leaders Value-Based Purchasing An Opportunity for Clinical Nurse Leaders Marjorie S. Wiggins, DNP, MBA, RN, FAAN, NEA-BC Senior Vice President, Patient Care Services/Chief Nursing Officer AACN-CNL Summit, Long

More information

Iowa Healthcare Collaborative (IHC) Iowa Report. CY2012 Healthcare-associated Infection (HAI) Data Collection and Reporting Guide

Iowa Healthcare Collaborative (IHC) Iowa Report. CY2012 Healthcare-associated Infection (HAI) Data Collection and Reporting Guide Iowa Healthcare Collaborative () Iowa Report Healthcare-associated Infection (HAI) Data Collection and Reporting Guide Revision Date: January 17, 2013 This document is intended to be a HAI data collection

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System

Medicare Inpatient Rehabilitation Facility Prospective Payment System Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2015 Overview, Resources, and Comment Submission On May 7, 2014, the Centers for

More information

How We Rate Hospitals

How We Rate Hospitals How We Rate Hospitals June 2014 1. Overview....................................................................... 2 2. Patient Outcomes 2.1 Avoiding infections.......................................................

More information

How Regulations Affect Coding and Documentation

How Regulations Affect Coding and Documentation How Regulations Affect Coding and Documentation Byline Deborah Neville, RHIA, CCS-P Director Revenue Cycle, Coding and Compliance for Elsevier, Inc. INTRODUCTION Regulations, laws, mandates, and guidelines

More information

List of Measures under Consideration for December 1, Page 1 of 329

List of Measures under Consideration for December 1, Page 1 of 329 Page 1 of 329 TABLE OF CONTENTS Overview... 3 Background... 3 Statutory Requirement... 4 Fulfilling DHHS s Requirement to Make Its Measures under Consideration Publicly Available... 5 Included Measures...

More information

September 8, 2015. Dear Mr. Slavitt,

September 8, 2015. Dear Mr. Slavitt, September 8, 2015 Mr. Andrew M. Slavitt Acting Administrator Centers for Medicare & Medicaid Services U.S. Department of Health and Human Services Hubert H. Humphrey Building, Room 445-G 200 Independence

More information

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017

Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Overview of the Hospital Value-Based Purchasing (VBP) Fiscal Year (FY) 2017 Audio for this event is available via INTERNET STREAMING. No telephone line is required. Computer speakers or headphones are

More information

National Hospital Inpatient Quality Reporting Measures Specifications Manual

National Hospital Inpatient Quality Reporting Measures Specifications Manual National Hospital Inpatient Quality Reporting Measures Specifications Manual Release Notes Version: 5.0 Release Notes Completed: March 9, 2015 Guidelines for Using Release Notes The Release Notes Version

More information

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013

Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Partnership for Healthcare Payment Reform Total Knee Replacement Pilot Quality Report Quarter 1 Quarter 4, 2013 Introduction This report outlines the total knee replacement pilot quality results for care

More information

New Jersey Delivery System Reform Incentive Program

New Jersey Delivery System Reform Incentive Program New Jersey Delivery System Reform Incentive Program The New Jersey Delivery System Reform Incentive Program (DSRIP) is part of New Jersey s Comprehensive Medicaid Waiver. The program provides incentive

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System

Medicare Inpatient Rehabilitation Facility Prospective Payment System Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief FINAL RULE Program Year: FFY 2015 Overview and Resources On August 6, 2014, the Centers for Medicare and Medicaid

More information

SCORING METHODOLOGY Fall 2015

SCORING METHODOLOGY Fall 2015 SCORING METHODOLOGY Fall 2015 HOSPITAL SAFETY SCORE Contents What is the Hospital Safety Score?... 4 Eligible and Excluded Hospitals... 4 Scoring Methodology... 5 Measures... 5 How Measures are Scored...

More information

Medicare Inpatient Rehabilitation Facility Prospective Payment System

Medicare Inpatient Rehabilitation Facility Prospective Payment System Medicare Inpatient Rehabilitation Facility Prospective Payment System Payment Rule Brief PROPOSED RULE Program Year: FFY 2016 Overview, Resources, and Comment Submission On April 23, 2015, the Centers

More information

HITECH Act Update: An Overview of the Medicare and Medicaid EHR Incentive Programs Regulations

HITECH Act Update: An Overview of the Medicare and Medicaid EHR Incentive Programs Regulations HITECH Act Update: An Overview of the Medicare and Medicaid EHR Incentive Programs Regulations The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was enacted as part of

More information

REPORT TO THE 26TH LEGISLATURE STATE OF HAWAII 2012

REPORT TO THE 26TH LEGISLATURE STATE OF HAWAII 2012 REPORT TO THE 26TH LEGISLATURE STATE OF HAWAII 2012 PURSUANT TO ACT 177(11), SESSION LAWS OF HAWAII, 2011, RELATING TO HEALTHCARE ASSOCIATED INFECTIONS REPORTING Prepared by: State of Hawaii Department

More information

Medicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009

Medicare & Medicaid EHR Incentive Program Final Rule. Implementing the American Recovery & Reinvestment Act of 2009 Medicare & Medicaid EHR Incentive Program Final Rule Implementing the American Recovery & Reinvestment Act of 2009 Overview American Recovery & Reinvestment Act (Recovery Act) February 2009 Medicare &

More information

Review of the Stroke and VTE Measure Sets

Review of the Stroke and VTE Measure Sets Review of the Stroke and VTE Measure Sets Vicky Agramonte, RN, MSN IPRO Quality Data Reporting and Improvement Project Presentation to NYS Hospitals January 29, 2013 The QIO Program CMS Leads a national

More information