HOP QDRP PPT New Abstractor October 2010

Hospital Outpatient Quality Data Reporting Program
(HOP QDRP)
Help, I’m a New Abstractor:
Guidance for Outpatient Quality Data Reporting
Presented by Tami Gendreau, RN, BSN
Project Coordinator, HOP QDRP Support Contractor
October 2010
1
• Overview for the new abstractor
• Requirements to participate
• Population definitions
• Abstractor information
• Abstraction tips
2
Outpatient Prospective Payment System (OPPS)
Final Rule
◦ Initiated with the CY 2008 Final Rule
◦ Initial implementation of the Hospital Outpatient
Quality Data Reporting Program (HOP QDRP)
◦ Hospitals began reporting data for 2008 services
◦ Reporting required for “subsection (d)” hospitals
to receive the full OPPS annual payment update
(APU)
3


Participation is voluntary; however, if a
hospital does not report data, the hospital will
risk losing 2.0% of its OPPS APU.
OPPS Proposed Rule
◦ On or around June 30th

OPPS Final Rule
◦ Must be on display by November 1st by statute
4
Public Reporting of Clinical Data


Data submitted to the Clinical Data Warehouse
are subject to being publicly reported on
Hospital Compare.
Hospitals will have an opportunity to review
the data prior to publication during the
designated preview periods.
5

Education
◦ Training materials
◦ Education conferences and archives

Tools
◦ HOPQDRP online
 Quick start guides
 New hospital packet
 Antibiotic tables for printing
◦ QualityNet.org
 Questions & Answers
 The QualityNet User's Manual and QualityNet Reports User's
Manual
6
HOP QDRP
Participation Requirements
7


Identify and maintain an active QualityNet Security
Administrator (SA); it is highly recommended that
two SAs be designated.
Complete the HOP QDRP online pledge through
“My QualityNet.”

Collect and report data on the required Measures.

Submit complete and accurate data
 CMS Abstraction & Reporting Tool (CART)
 Third party vendor
8
HOP QDRP Deadlines
Q2-2010
Population and Sampling
Data Due
Nov 1, 2010*
Q3-2010
Feb 1, 2011**
Feb 1, 2011
Q4-2010
May 1, 2011**
May 1, 2011
Q1-2011
Feb 1, 2012**
Feb 1, 2012
Q2-2011
May 1, 2012**
May 1, 2012
Q3-2011
Aug 1, 2012**
Aug 1, 2012
Encounter Quarter
Clinical Data Due
Nov 1, 2010
* Submission of Population and Sampling data for these quarters is voluntary.
** Proposed for CY 2011: Mandatory submission of Population and Sampling data for these
quarters
9

Submission of data is voluntary for five or fewer
cases per Measure Topic.
• If the total AMI and CP cases combined is five or
fewer, providers are NOT required to submit data for
the Measure Topic. However, providers may voluntary
choose to do so.
• If the total AMI and CP cases combined is greater than
five, providers need to abstract and submit data for
the cases in both populations.
10
HOP QDRP Measures

AMI Cardiac Care
◦ OP-1 Median Time to Fibrinolysis
◦ OP-2 Fibrinolytic Therapy Received Within 30 Minutes
◦ OP-3 Median Time to Transfer to Another Facility for Acute
Coronary Intervention
◦ OP-4 Aspirin at Arrival
◦ OP-5 Median Time to ECG

Surgical Care
◦ OP-6 Timing of Antibiotic Prophylaxis
◦ OP-7 Prophylactic Antibiotic Selection for Surgical Patients
11
HOP QDRP Measures

Outpatient Imaging Efficiency Measures
◦ OP-8 MRI Lumbar Spine for Low Back Pain
◦ OP-9 Mammography Follow-up Rates
◦ OP-10 Abdomen CT Use of Contrast Material
◦ OP-11 Thorax CT Use of Contrast Material
These four Measures are collected from outpatient hospital
CLAIMS data. No abstraction is done by the hospital.
12
Population Definitions
13
AMI Cardiac Care

Emergency department (ED) patients must have:
◦ Discharge/Transfer Code
• 02 (short-term general hospital)
• 43 (federal facility)
◦
Evaluation & Management (E/M) Code
• Table 1.0. found in Appendix A of the OPPS Specifications Manual
◦ Acute Myocardial Infarction and/or Chest Pain Diagnosis
• ICD-9-CM code from Table 1.1 or 1.1a. Appendix A of the OPPS Specifications
Manual
14
AMI Cardiac Care

AMI patients must have an ICD-9-CM code as the
PRINCIPAL diagnosis
◦ Appendix Table 1.1

Chest pain patients must have an ICD-9-CM code
as a principle diagnosis or other diagnosis
◦ Appendix Table 1.1a
15
Surgical Care

A CPT code from Appendix A, Table 6.0

The CPT codes found in Appendix A, Table 6.0,
are stratified into Tables 6.1 – 6.7 to aid in
verifying correct antibiotic use

Note: Discharge/transfer status codes DO NOT
apply to the surgery Measures
16
Abstractor Information
17
Specifications Manual

Go to www.qualitynet.org, place cursor over
Hospitals-Outpatient menu
 Click the Specifications Manual link to download
the manual
 Click the link for the desired version of the
Specifications Manual you intend to download
18
19
CMS Abstraction & Reporting Tool
(CART)


If a provider does not use a vendor for abstracting
HOP QDRP data, the provider will need to download
CART from www.qualitynet.org.
Inpatient and Outpatient CART are separate Tools.
20
CART

Place cursor over Hospitals-Outpatient menu.
• Click Data Collection (& CART) in the drop-down menu.
• Click CART Downloads & Info.

Call the QualityNet Help Desk for assistance at
1-866-288-8912.
21
22
Using a Vendor


Vendors must be authorized electronically by
a provider to submit outpatient data on a
hospital’s behalf.
The vendor authorization for outpatient is
separate and distinct from the inpatient
vendor authorization.
23
Using a Vendor



There is no required deadline (end date) for
completing the vendor authorization form.
Your vendor cannot transmit data until you
complete the vendor authorization process.
The vendor cannot transmit data after an end
date if you have assigned one.
24
Using a Vendor


Vendors for the HOP QDRP do not need to be
approved by CMS.
If you are required or wish to send your HOP data to
The Joint Commission (TJC), your vendor must be a
Joint Commission approved vendor.
For more information on TJC vendors, please visit www.jointcommission.org.
25
Hospital Reports
The hospital is ultimately responsible for ensuring its
clinical data has been uploaded into the Clinical Data
Warehouse; this applies even if your facility uses a vendor.
◦ Check your Provider Participation Report (PPR).
◦ Check your HOP QDRP Submission Detail Report.
◦ Check your Population & Sampling Grid.
26
Population & Sampling

Population and sampling is voluntary for CY 2010

Proposed for CY 2011 episodes of care
◦Mandatory submission of Population & Sampling data affecting
CY 2012 payment update
27
Population & Sampling

Population & Sampling is voluntary for CY 2010

Proposed for CY 2011 episodes of care
◦ Mandatory submission of Population & Sampling data
affecting CY 2012 payment update
28
Validation

Proposed for CY 2012 Payment Determination
◦ Proposed- Sample 800 randomly selected participating hospitals
each year
◦ Proposed- Up to a total of 48 cases (12 per quarter) from the
total number of cases successfully submitted to the OPPS
Clinical Warehouse
◦ Proposed- Request records quarterly
◦ Proposed- Records must be submitted and received within 45
calendar days following the date of the initial CDAC request
29
Abstraction Tips
30
Preliminary Steps to Reporting Data
1.
Identify internal data sources
–
–
2.
Vendor selecting the records?
Your hospital selecting records?
Identify patient population(s)
– Be sure to check all ICD-9-CM and CPT codes
o AMI Cardiac Care
o Surgical Care
31
Specifications Manual

Abstractors should to refer to the Specifications
Manual. The manual provides the abstractor with
definitions and information necessary to abstract
the record correctly.

Selected professional references for each of the
Measures can be found at the end of each of the
Measure Information Forms (MIFs).
32
Tools

Thoroughly understand the data abstraction tool being
used.

Use the Specifications Manual as a reference for each
question until the abstractor becomes familiar with the
data abstraction tool and guidelines related to each
question.

Become familiar with QualityNet and the Web-based
question-and-answer system for the HOP QDRP.
o The HOP QDRP does not use QUEST.
33
Chart Abstraction

What you see is what you abstract.

Do not use clinical judgment when abstracting.

The chart you read and abstract may be
requested for validation.
34


The medical record has to be legible.
If documentation is illegible, it will not be
abstracted.
35
What to Abstract - All Records
 Name
 Sex
 DOB
 Race
 Hispanic or Latino
 ZIP
 Your hospital identifier
36
Program Codes

ICD-9-CM Code
◦ AMI/CP

Evaluation/Management (E/M) Code
◦ AMI/CP

CPT Code
◦ Surgery
37
Patient Identifier & Payment Source



A Health Insurance Claim (HIC) number is not
mandatory; if used, it must be correct.
If Medicare is listed as the primary, secondary,
tertiary, or even lower down on the list or payers,
select Value “1” for source of payment.
Medicare HMO/Medicare Advantage would abstract as
Medicare, Value “1.”
38
Face Sheet


Patient’s name, address, DOB, insurance
(Medicare A/B with HIC#)
Time of registration, which may or may not
be the arrival time
39
AMI Cardiac Care

Evaluation and Management Code
o You need the E/M Code for all AMI or CP cases.
o The E/M codes are used for billing the appropriate
level of care in the ED.
o The E/M codes determining the HOP population are
listed in the Specifications Manual, Appendix A.
40
AMI Cardiac Care



Observation is NOT a disposition code. If the patient
goes to observation and is then transferred as 02 or 43,
the case is included and abstracted.
Observation patients remain outpatients until admitted
as inpatients or discharged.
Observation patients remain ED patients until
discharged, if arrival originated in the ED.
41
AMI Cardiac Care



Do not try to read and interpret the electrocardiogram (ECG)
yourself.
Initial ECG Interpretation
◦ If a fibrinolytic was not given, was it because the ECG done
closest to arrival didn’t show an MI?
Look at the Inclusion/Exclusion list in the Specifications
Manual Data Dictionary.
◦ Words such as borderline, cannot exclude, could be, may
have had, questionable, suspect, suggestive of, etc., are
exclusions.
42
AMI Cardiac Care

Arrival time
◦ Ambulance ECG time
 Time on the ambulance ECG can be used if done within
60 minutes prior to arrival.
◦ Hospital ECG time
• If ECG is done prior to triage (or any other note in the
record), that time will be the arrival time.
43
AMI Cardiac Care

Median time to ECG
o This is a timing Measure.
o There is no pass or fail.
o American Heart Association/American College of
Cardiology (AHA/ACC) recommends 10 minutes or
less.
44
AMI Cardiac Care

ED arrival time
• Abstract the earliest time the patient arrived in the
ED.
• Don’t use the run sheet from the ambulance for the
arrival time.
• You can use the triage sheet, the ED ECG, and the
face sheet (if it makes sense).
45
AMI Cardiac Care

Discharge time
◦ Abstract the time documented in the medical record
when the patient physically left your emergency
department
◦ You may abstract from any document that is a
permanent part of the medical record
 Nursing notes
 Transfer sheet
 ED transfer logs
46
AMI Cardiac Care
Patients who go to a cath lab from the ED
and then to another hospital without being
admitted are included in the population if
they meet all HOP QDRP criteria.
47
AMI Cardiac Care
•
•
•
OP-1 (Median Time to Fibrinolysis) is a timing
Measure. There is no pass or fail.
OP-2 (Fibrinolytic received w/in 30 minutes)is a yes
or no. The only reason for not giving the drug would be
a contraindication.
OP-3 (Median time to transfer)is a variable timing
Measure. Only the time will be reported. Who or why
the patient didn’t get a fibrinolytic will NOT be
reported.
48
AMI Cardiac Care

Chest Pain
◦ Chest pain is cardiac until ruled out as otherwise.
◦ Your coder also has made a chest pain determination
decision by coding with one of the codes from
Appendix A, Table 1.1a.
49
Surgical Care



An infection is an infection if it’s called an
infection.
Not all “itis’s” are infections.
If a patient has an “itis” and is on an antibiotic,
it’s probably an infection.
50
Surgical Care

Arrival Time
o What was the documented time that the patient
arrived?
o Look through the record and find the earliest time
that makes sense.
o If the surgical patient has a face sheet with a time
and date two days prior to arrival because he/she
came in for lab work, don’t use it.
51
Surgical Care

CPT code must be in Table 6.0 Appendix A.
◦ If the CPT code is not in one of the tables, the case
does not get abstracted.

Tables 6.1 through 6.7 are broken out by type
of procedure to make antibiotic selection
easier.
52
Surgical Care
If an incision time is not documented in the hospital outpatient
record, follow the priority order list of synonyms. If multiple
times are found, use the earliest time among the highest priority
of synonyms.
◦First priority: Incision time
◦Second priority: Surgery start/begin time or operation start time
or procedure start time or start of surgery (SOS) or case start
time
◦Third priority: Anesthesia begin time or anesthesia start time or
operating room start time
53
Communication

Auto-Notifications
◦ Auto-Notification lists, “ListServes,” are used to
disseminate timely and pertinent information
related to quality initiatives.
◦ Register your e-mail to receive notification of
important information related to the HOP QDRP.
◦ Access registration for notifications on the
QualityNet Home page.
54
Click here to join the HOP QDRP
ListServe.
55
HOP QDRP Assistance

QualityNet Website
◦ Hospitals-Outpatient Questions/Answers

HOP QDRP Website
◦ www.hopqdrponline.com
HOP QDRP Support Contractor
FMQAI 1-866-800-8756
56
1. Questions/Answers database
2. Submit a question
57
HOP QDRP
SUPPORT CONTRACTOR
5201 W. Kennedy Blvd Suite 900
Tampa, FL 33609
1-866-800-8756
hopqdrp@fmqai.com
This material was prepared by FMQAI, the Support Center for the Hospital Outpatient Quality Data Reporting
Program (HOP QDRP), under contract with the Centers for Medicare & Medicaid Services (CMS), an agency
of the U.S. Department of Health and Human Services (HHS). The contents presented do not necessarily
reflect CMS policy. FL2010SS1T112711931
58