DASpecialists, LLC

From GoogleGroup- Hospital Quality Share

Q: Are there any benchmarks for the new ED Throughput Measures?

A #1: The ENA has some benchmark data and you have to pay for it but CMS won't until they receive a few quarters in the warehouse for analysis. Estimation of benchmarks as of now are believed to be:

*Door to evaluation is 15 minutes

*Door in to door out is 81 minutes.

A #2: The most recent Hospital Preview Reports from Qnet should have that on it for the Inpatient Program.  We are not reporting our ED measures until January but the ones we printed in November had the ED-1 & ED-2 Top 10%, State Performance and National Performance Benchmarks.  They were:

 ED-1: Top 10% = 132 minutes, State (OR)= 229 minutes, Nat'l=210 minutes

 ED-2: Top 10% = 25 minutes, State (OR)= 88 minutes, Nat'l = 68 minutes

Hope this is helpful.

Clinical Quality Analyst, Medford, Oregon

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From the FL QIO/HOP QDRP Support Contractor News, Volume 1, Issue 6:

"Data collection for ED-Throughput measures begins January 1, 2012, and

benchmarks will not be determined until after data collection is completed for

the first two quarters’ data, at a minimum. Although other associations may

publish benchmark data on emergency measures, at this time CMS has no formal

benchmarks established for these measures. For many median time measures, the

closer to zero indicates more efficiency in throughput of patients."

 ______________________________________

Q:  We let the patients know that the surgeon would prefer he/she waits until after 30 days post surgery date for the vaccines. With this knowledge the patients refuse the vaccines.

A:  This is a great example of "gaming" the measures. There is no contraindication to vaccinating a heart surgery patient and frankly it is inappropriate to do this. That is why NQF insisted that the global measures be captured in such a way to allow for stratification of all of the numerator components - the global measures can be calculated and show which hospitals have the highest rates of "refusal" specifically to identify gaming.

 Some of you know that I have now been asked to serve as an expert witness in a number of lawsuits against hospitals for failure to vaccinate their inpatients. The scenario is usually the same - the hospital does not vaccinate, the patient goes home and gets the disease (most suits have been about pneumococcal disease), and then suffers severe consequences. Indeed in the reported cases of pneumococcal disease, most of the patients have developed purpura fulminans resulting in amputations, etc. Atul Gwande in so bme of his lectures has highlighted one of these cases as an example of missing the opportunity to do a simple and cheap intervention (PPSV23) to prevent disease.

 I will say it again - there is no contraindication to vaccination of surgical patients. Don't miss the opportunity because those good intentions to give the vaccine after the patient goes home are usually not fulfilled. I don't know of many cardiac surgeons that give PPSV23 in their office.

 If they don't want them vaccinated in the hospital they do have an alternative - give it to their elective patients before they come to the hospital.

 Do what is right for the patient - not what is based on some myth in the mind of the caregiver...

Dale Bratzler

What else would you like to see posted here?  Shoot us an e-mail at support@daspecialists.com and we will post your thoughts and comments on this page.

A HHS Announces

ICD-10 postponment

Health and Human Services (HHS) Secretary Kathleen G. Sebelius has announced that HHS will initiate a process to postpone the date by which certain healthcare entities have to comply with ICD-10. Entities covered under HIPAA will be required to use the ICD-10 diagnostic and procedure codes.

The final rule adopting ICD-10 as a standard was published in January 2009 and set an orginial compliance date of October 1, 2013 - a delay of two years from the original compliance date outlined in the 2008 proposed rule. A new date is under consideration and will be announced in the future.

This announcement follows the Centers for Medicare and Medicaid Services (CMS) stating that the CMS will reconsider the ICD-10 implementation timeline as well.

                             -source: cms.hhs.gov

 A Quick Overview of CAAR 

In an effort to increase data reliability, The Joint Commission has implemented a voluntary program of validation for core measures titled Category Assignment Agreement Rate (CAAR).  This program is a one-to-one comparison of the original abstraction (and abstractor) and a re-abstraction.  While currently voluntary, expectations are the program will eventually become mandatory.  Current objectives include a re-abstraction of 12 cases per quarter sampled from abstractions previously submitted to TJC. There should be at least one of each time case that was previously submitted including Inpatient, Outpatient and Behavioral Health.  The objective is to determine consistency in abstraction and to highlight knowledge deficiencies between abstractors, providing an opportunity for enhanced learning...

The Joint Commission has mandated all TJC-approved PMS software vendors develop and implement a module within their applications in order to process and provide comparison capabilities for re-abstraction efforts.  The software vendors are required to report to TJC which hospitals are participating at this point, but are not asking for validation percentages at this time.  Information is not publicly reported, but again, there is an expectation it will.

Software application protocols may vary, but re-abstraction reports reflecting mis-matches should be available in the CAAR module.  Information from the re-abstractions will not be reflected in reports from the original submissions.

Hospitals are encouraged to contact their specific PMS vendor.  DASpecialists does provide CAAR/IRR abstraction services.

OCR begins HIPAA

Audits

The HHS Office of Civil Rights (OCR), which enforces the HIPAA Privacy Rule, has announced the beginning of HIPPA audits to determine if covered entities, such as hospitals, payers and claims clearinghouses, are in compliance with the privacy, security and breach notification guidelines and rules.  According to consultant firm KPMG will conduct up to 150 audits in 2012.  The audits will beginning with a series of 20 initial audits to determine if the new audit protocols developed by KPMG are viable or need revision.  OCR’s focus on auditing various sized covered entities with the initial round of audits.  Business associates (vendors) are projected to be included in the future.

OCR is notifying selected facilities and entities in writing, but has not provided information on how they will be selected.  Information will be provided to explain the procedures and outline the expected document and information requests.  Selected entities will have 10 days to respond but can also expect an on-site visit between 30 and 90 days.  For more information, visit the OCR website at http://www.hhs.gov/ocr/privacy/

CHANGES TO

QNET QUEST

Friday, December 30, 2011: The Centers for Medicare & Medicaid Services (CMS) will replace QualityNet Quest with a new question and answer tool in early January.  The new tool is currently used by the Hospital Outpatient Reporting program and by CMS for their frequently asked questions. 

The tool will be available on QualityNet and will include the Quality Improvement Organization and Hospital Inpatient Reporting questions and answers.

A recorded training for using the new tool will be posted to QualityNet along with other resources. Notification will be sent when the tool is available in January.

No changes will be made to the Hospital Outpatient Reporting question and answer system.

 Please notify your internal point of contact if you have any questions. He or she may contact the QualityNet Help Desk if additional information and/or assistance are needed.

Thank you,

QualityNet Notification