ahrq psis and iqis in national pay for reporting september 14, 2009 ahrq qi conference shaheen...
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AHRQ PSIs and IQIs AHRQ PSIs and IQIs in National Pay for Reportingin National Pay for Reporting
September 14, 2009
AHRQ QI Conference
Shaheen Halim, Ph.D.
Centers for Medicare & Medicaid Services
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CMS’ Office of Clinical Standards and Quality
Lead on quality and clinical issues and policies for the Agency’s programs. Coordinates with external organizations and Agencies.
Promote and monitor quality and quality improvement for the Agency’s programs. Evaluates the success of interventions
Develop, evaluate, adopt and support performance measurement systems (quality indicators) to evaluate care provided to CMS beneficiaries
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OCSQ’s Quality Measurement and Health Assessment Group
Lead for measure development and public reporting of quality measures:
● Hospital Inpatient and Outpatient
● Physician
● Nursing Home
● Home Health
● ESRD
Websites available on http://www.Medicare.gov
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Hospital Pay for Reporting Programs
Reporting Hospital Quality for Annual Payment Update (RHQDAPU)
● MMA 2003: .4% APU to report 10 measure starter set
● DRA 2005: 2% APU to report expanded measure set … 44 measures for the 2010 payment determination
Hospital Outpatient Quality Data Reporting Program (HOP QDRP)
● TRHCA 2006: 2% 2009 APU for 7 measures, 11 measures for 2010 APU, including 4 claims-based measures on Imaging Efficiency
RHQDAPU Over the Years
2004: 10 process measures (AMI, HF, PN, SCIP)
2006: 21 process measures (11 added)
2007: 30-day mortality measures, HCAHPS
2008: 30-day readmission, AHRQ measures, structural measure
2009: 2 structural measures
Currently 46 measures in RHQDAPU Program 27 process, 15 claims-based outcome measures, 3 structural,
HCAHPS
Desire to expand outcomes measurement in RHQDAPU
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AHRQ PSIs and IQIsin RHQDAPU
9 AHRQ Indicators were adopted into CMS’ Reporting Hospital Quality Data for Annual Payment Update Program (RHQDAPU) in FY 2009 IPPS Rule
Allows expansion of RHQDAPU program topics to include Patient Safety, Complications, and In-hospital mortality
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Patient Safety Indicators
AHRQ Patient Safety Indicators adopted: PSI 4: Death among surgical patients with serious, treatable complicationsPSI 6: Iatrogenic PneumothoraxPSI 14: Postoperative Wound DehiscencePSI 15: Accidental Puncture or Laceration
PSI Composite: Complications/Patient Safety for Selected Indicators
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Complication/patient safety for selected indicators
PSI #03 Decubitus Ulcer
PSI #06 Iatrogenic Pneumothorax
PSI #07 Infection Due To Medical Care
PSI #08 Postop Hip Fracture
PSI #09 Postop Hemorrhage or Hematoma
PSI #10 PostopPhysioMetabolDerangmt
PSI #11 Postop Respiratory Failure
PSI #12 Postop PE Or DVT
PSI #13 Postop Sepsis
PSI #14 Postop Wound Dehiscence
PSI #15 Accidental Puncture/Laceration
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Inpatient Quality Indicators
AHRQ Inpatient Quality Indicators adopted:
IQI 11: Abdominal Aortic Aneurysm (AAA) Repair Mortality Rate
IQI 19: Hip Fracture Mortality Rate
IQI Composite: Mortality for Selected Procedures
IQI Composite: Mortality for Selected Conditions
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Mortality for Selected Procedures
IQI #08 In-Hosp Mort Esophageal Resection
IQI #09 In-Hosp Mort Pancreatic Resection
IQI #11 In-Hosp Mort AAA Repair
IQI #12 In-Hosp Mort CABG
IQI #13 In-Hosp Mort Craniotomy
IQI #14 In-Hosp Mort Hip Replacement
IQI #30 In-Hosp Mort PTCA
IQI #31 In-Hosp Mort Carotid Endarterectomy
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Mortality for Selected Conditions
IQI #15 In-Hosp Mort AMI
IQI #16 In-Hosp Mort CHF
IQI #17 In-Hosp Mort Stroke
IQI #18 In-Hosp Mort GI Hemorrhage
IQI #19 In-Hosp Mort Hip Fracture
IQI #20 In-Hosp Mort Pneumonia
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CMS 2009 Dry Run
CMS conducts “Dry run” for claims-based measures to provide methodology information about the measures prior to formal implementation.
Provide hospitals with an opportunity to provide CMS with feedback to inform implementation.
Opportunity to answer questions regarding measure methodology and calculations.
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CMS 2009 Dry Run
Hospital-Specific Reports were generated and released to hospitals via their QualityNet accounts on February 27, 2009. Hospital Specific Performance National, State, and Regional summary statistics
Mock-report and Summary Statistics made available for download on QualityNet.Began 30-day question and comment period to end April 2, 2009.Webinars to provide further information and to answer frequently asked questions about the dry run.
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CMS 2009 Dry Run
● 2006 Inpatient Medicare claims (100% file) Data obtained from Dartmouth Medical School 10 diagnostic and 6 procedural codes were reported No age restriction
AHRQ PSI and IQI software v3.2 Excludes claims missing Age or Sex from all analyses Excludes claims missing other variables (e.g. Admission Source,
Admission Type, Disposition Status, DRG, LOS, etc.) from the denominators of specific measures
3M™ APR™-DRG V3.2 Limited License Grouper software AHRQ PSI and IQI software use this for risk adjustment APR-DRG software downloaded from the AHRQ website
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CMS 2009 Dry Run
● Modifications to our claims data were required because the AHRQ software was designed for use with HCUP, not Medicare claims data
The levels for some categorical variables required reassignment (e.g. Admission Source, Race, etc.)
For example, Hispanic = 5 in our data, AHRQ software specifies that Hispanic = 3
MDC (Major Diagnostic Category) was assigned using the CMS DRG version 23 and 24 Relative Weights files
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CMS 2009 Dry Run
● AHRQ PSI and IQI software Defines the inclusion and exclusion criteria for each
indicator
Generates the numerator, denominator, observed, expected, risk-adjusted and smoothed rates for each indicator
Indicators were reported as rates per 1000 Rate = 200 (per 1000) Rate calculated by multiplying x 1000 = 200 (per 1000)
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CMS 2009 Dry Run
● Population reference: national rates based upon the HCUP State Inpatient Database (SID) Includes 90 million discharges in 2002, 2003, and 2004
from the 38 states participating in the HCUP SID
Equal weight option applied for the Composite Scores In this case, each component indicator is assigned an
identical weight based on the number of indicators. That is, the weight equals 1 divided by the number of indicators in the composite
For example, 1/8 = 0.1250
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CMS 2009 Dry Run
Hospital Specific Reports provided Observed, Expected, Risk Adjusted and Smoothed Rates
Provided definitions for each of the 4 rates and guidance on how to interpret and use them.
State, National and Regional (HHS Region) summary statistics provided for comparison
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2010 Implementation
Initial display onhttp://www.cms.hhs.gov tentatively scheduled for January 2010.
Will be calculated using Medicare claims spanning July 1, 2007 to June 30, 2008 for the FY 2010 payment determination
Hospital preview reports tentatively scheduled for November/December 2009
Reporting on Hospital Compare tentatively scheduled for June 2010 using calculations spanning July 1, 2008 to June 30, 2009.
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Future Implementation
Include Observed Numerator and Denominator in hospital previews
Include Confidence Intervals for rates
Consumer testing to inform future display and language for the AHRQ PSIs and IQIs on Hospital Compare
Possible display of composites similar to current bucket approach for 30-day mortality and 30-day readmission.
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Example Display
Future Issues
Examine POA for future use
Small N threshold
Which rate (predicted or smoothed) for consumer display
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