Centers for Medicare and Medicaid Services (CMS)
Proposed Requirements for the
FY2007 Annual Payment Update (APU)
POTENTIAL CHANGES!!!
According to the "Federal Register/Vol. 71, No. 79/Tuesday, April 25, 2006/Proposed Rules", hospitals will be required to submit not only the 10 starter set quality measures that they submitted for the Annual Payment Update for FY2006 but will be required to expand the submission of data to include additional measures for the AMI, HF, and PN sets and to add the Surgical Infection Prevention (SIP) set. All 21 measures (8-AMI, 4-HF, 7-PN, and 2-SIP) that will be required are those endorsed by the National Quality Forum (NQF) and are common to CMS and the JCAHO Core Measure Sets.
The Federal rule is still in draft and changes could be made before it is enacted in its final form. However, if the rule is unchanged, hospitals that fail to report the 21 measures would lose 2% of their annual payment update. If enacted as proposed the Federal rule would require data to be reported for these additional measures for patient discharges beginning with January 1, 2006 forward.
If you are already reviewing the patient records for any of these additional measures you are breathing a sign of relief. This would include any facility that is currently collecting and submitting data for the AMI, HF, PN, and SIP core measure sets to JCAHO. All the additional measures are included in these sets.
"What will I do if this proposal is enacted?"
If your facility is using QM Data Solutions as your Core Measure vendor and QMSTM as the data collection tool, you can begin to collect these additional measures NOW.
Not only would you then be able to submit the additional data with 1st Quarter 2006 data which is due to QM Data Solutions on June 1st but you would also have the availability of running a report that would show you your facility's rates for these additional measures. Areas for improvement would then be easily identified and processes begun to improve the performance in these areas.
The data would be processed but not submitted to CMS and/or to JCAHO until it was "mandatory" or until QM Data Solutions was instructed and authorized to do so for your facility.
Contact Information
If you have questions or would like additional information, please contact the QMS™ support staff at 888-364-6424 or at QMS@QMDATA.COM.
The Verification Process
QMS™ has been verified by JCAHO for all 5 core measure sets (AMI, CAP, HF, PR, and SIP). Please read this page and the QMS™ core measures brochure for more information.
Selecting QM Data Solutions as Your Vendor
Complete the core measures selection form and fax it to JCAHO and QM Data Solutions.
Facility Requirements
All acute care hospitals accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) will be required to implement NEW performance measurements called Core Measures as of July 1, 2002. JCAHO has decided on four (4) sets of Core Measures that the hospital staff can select from: Heart Failure (HF), Community Acquired Pneumonia (CAP), Acute Myocardial Infarction (AMI), and Pregnancy and Related Conditions (PR). The goal of JCAHO is to standardize the measures and their definitions so that comparison will be across all hospitals accredited by JCAHO. All vendors listed by JCAHO that embed the core measure sets into their systems must meet the same standards.
The number of Core Measure sets required to be implemented depends upon the specific hospital’s service population. These requirements are outlined in the table below along with the key dates for implementation. (More information can be found on JCAHO’s website - http://www.jcaho.org/ - under the section ORYX®/Performance Measurement.)
Your Next Step
Even though the June and July dates are still months away, we suggest you begin preparation now for the implementation of this project. Suggestions on how you might begin are:
I. |
Review the information on JCAHO’s website and/or in the literature about the scope of the project and specifics about the core measure sets. |
II. |
Decide on the measure set(s) that best meet the requirements for implementation at your facility. |
III. |
Discuss with your selected vendor (e.g., QMS™) any data element requirements for collecting data for the set(s) selected. |
IV. |
Work with your vendor and the Information Technology Department (IT) staff at your facility to obtain patient specific information for those patients that fall into the ICD diagnostic groups selected. (A list of the ICD-9 codes used for core measures is available upon request.) |
V. |
At the same time you are working with your IT staff and vendor, develop processes that will be used to review each patient discharge record for the specific measures within the set(s) selected. |
VI. |
Do a “pilot” review prior to the July 2002 implementation date. |
While we plan to remain a vendor for those currently submitting performance measures, the QMS™ staff is actively preparing to embed the core measure sets. An agreement with JCAHO has been executed, programming is being completed, testing is under way, educational/training materials for participants are being developed, and questions can be answered.
Contact Information
Please contact QM Data Solutions at 888-364-6424 for more information.
JCAHO's Core Performance Measures
Dates for Implementation |
| By 6/30/2002 |
Hospitals formally select core measure sets based on health care services they provide: |
● |
If the hospital serves patient populations with conditions that correspond with two or more core measure sets, the hospital should select two of the initial four sets and submit data via their selected measurement system. The hospital will no longer be required to collect and transmit data on their non-core measures. |
● |
A hospital that can only identify one core measure set related to its health care services will collect data on that core measure set and, reduce its current non-core measure requirements from six measures to three. Core and non-core data will still be submitted via the selected measurement system. |
● |
Hospitals that cannot identify any core measures related to their health care services will continue to collect and transmit data via their selected measurement system using their six (6) non-core measures. |
| July 2002 |
Hospitals begin data collection for July discharges. |
| By 1/30/2003 |
Joint Commission receives first core measure data for the July 1 to September 30, 2002 quarter. The due date is approximately four months from the end of the last month of the reporting quarter. |
