CMS Issues Guidelines for
Submitting Hospital Quality Data
February 6, 2004 - The recently passed Medicare legislation
includes a provision that links the level of a hospital's
inpatient reimbursement to the hospital's submission of health
care quality data to the Centers for Medicare and Medicaid
Services (CMS). Beginning in FY 2005, under the legislation,
all hospitals will receive a full market basket update if
they submit their data for ten indicators that are endorsed
by CMS. The indicators are also part of the National Voluntary
Hospital Reporting Initiative supported by the AAMC, American
Hospital Association (AHA) and the Federation of American
Hospitals (FAH). The indicators are:
Heart Attack (Acute Myocardial Infarction)
- Was aspirin given to the patient upon arrival at the
hospital?
- Was aspirin prescribed when the patient was discharged?
- Was a beta-blocker given to the patient upon arrival
at the hospital?
- Was a beta-blocker prescribed when the patient was discharged?
- Was an ACE Inhibitor given for the patient with heart
failure?
Heart Failure
- Did the patient get an assessment of his or her heart
function?
- Was an ACE Inhibitor given to the patient?
Pneumonia
- Was an antibiotic given to the patient in a timely way?
- Had a patient received a Pneumococcal vaccination?
- Was the patient's oxygen level assessed?
Hospitals that choose not to participate will receive the
hospital market basket minus 0.4 percent for FY 2005. For
hospitals that report data, the Federal Register guidelines
also require that:
- Hospitals must sign up with QNET Exchange, the Quality
Improvement Organizations' data warehouse, by June 1.
- Hospitals' data for all ten quality measures included
in the Voluntary Hospital Reporting Initiative must be
submitted to the QNET data warehouse by July 1, and should
reflect patient discharges during the most recent quarter
available. All patient data must be submitted, not just
Medicare patient data.
- Hospitals whose data submission is started but not completed
by July 1 will be given a 30-day grace period to complete
their submission.
Information:
Jennifer Faerberg, DHCA-Project Director
AAMC Office of Governmental Relations
jfishburn@aamc.org
(202) 828-6221
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