Hospitals : Public Reporting: Hospital Quality Alliance (HQA) and Annual Payment Update (APU) Initiative
Hospital Quality Alliance (HQA)
The Hospital Quality Alliance, formerly the National Voluntary Hospital Reporting Initiative (NVHRI), is a joint effort initiated by the American Hospital Association (AHA), the Federation of American Hospitals and the Association of American Medical Colleges. The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission are also partners in this process.
The HQA began with the public reporting of 10 quality measures related to treatment of acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) patients. Beginning with January 2007 discharges, the HQA measure set was expanded to 24 quality measures, including five surgical care measures. The HQA has also added the public reporting of AMI, HF, and PN mortality measures and Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) survey data; these data were publicly reported beginning in the fall 2007. Hospitals voluntarily agreed to have these measures reported publicly on the Hospital Compare Web site. This Web site is accessible to providers and consumers.
The HQA uses QualityNet and the Quality Improvement Organization (QIO) Clinical Warehouse to collect data on the quality measures.
To participate in the HQA, hospitals must have completed the following steps:
- Hospitals with ORYXtm vendors authorized their vendors, through NMMRA, to transmit data to the QIO Clinical Warehouse
- Hospitals without vendors used an approved abstraction tool such as the CMS Abstraction and Reporting Tool (CART) to collect data
- Completed the AHA Quality Initiative pledge form
- Registered a QualityNet administrator and uploaded data to the QIO Clinical Warehouse via QualityNet
Read more about the AHA Quality Initiative.
Hospital Inpatient Quality Reporting Program (formerly known as Reporting Hospital Quality Data for Annual Payment Update)
With passage of the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003, Congress provided a financial incentive for all prospective payment system (PPS) hospitals to voluntarily report quality of care information so that consumers can compare care and make better-informed decisions [Section 501(b)].
Under the resulting Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) initiative, now known as the Hospital Inpatient Quality Reporting Program, hospitals submit data for specific quality measures for health conditions common among people with Medicare, and which typically result in hospitalization.
For fiscal year (FY) payment updates in 2005 and 2006, CMS required PPS hospitals to continuously submit data regarding 10 quality measures for three medical conditions: acute myocardial infarction (AMI), heart failure (HF) and pneumonia. PPS hospitals that did not participate in the RHQDAPU initiative by reporting the required data by the established deadlines received a 0.4 percentage point reduction in their APU from Medicare. On Aug. 1, 2006, CMS published an update to the RHQDAPU. For the FY 2007 APU, CMS required PPS hospitals to submit data on 21 quality measures for public reporting for four medical conditions: AMI, HF, pneumonia, and surgical infection. For the FY 2008 APU, CMS published another update and now requires PPS hospitals to submit data on 24 quality measures, mortality measures, and HCHAPS data. On September 16, 2010, CMS changed the name of its pay-for-reporting program from RHQDAPU to the Hospital Inpatient Quality Reporting Program.
NMMRA developed two learning tools to help introduce existing and new staff to the RHQDAPU initiative. Reporting Core Measures gives a brief overview of the initiative and its implications. The Art of Documentation provides a quick reference guide to properly document care provided to patients.
Compare the measures for which hospitals collect data for the HQA, APU, and other reporting intiatives. For additional information, read the CMS Fact Sheet on the reporting program and the how to participate.
CMS Abstraction and Reporting Tool (CART)
CMS developed the free CART data abstraction tool to allow health care providers to collect and analyze quality improvement data on any of the hospital quality improvement measures. Through data collection, retrospective analyses and real-time reporting, CART enables hospitals to comprehensively evaluate and manage quality improvement efforts.
Who Will Benefit From Using CART?
- Hospitals accredited by the Joint Commission that choose to work on improving measures that they did not select to report to the Joint Commission
- Any hospital that does not have a data abstraction and analysis system in place to monitor its performance on the CMS quality of care measures
- Hospitals that wish to report data on the CMS quality measures to participate in the Hospital Quality Alliance (HQA), formerly the National Voluntary Hospital Reporting Initiative (NVHRI), or the Hospital Inpatient Quality Reporting Program, formerly known as RHQDAPU
CART's key functions and benefits include:
- Meets CMS measurement specifications for performance monitoring and data collection with a single application
- Allows for concurrent data collection and reporting
- Maintains security of patient data, including Health Information Portability and Accountability Act (HIPAA) compliance
- Receives updates and enhancements to meet quickly evolving quality improvement needs
- Performs real-time and/or retrospective analyses
- Identifies areas for new system changes or enhancements to existing systems based on data collected
- Available at no cost to the hospital
- User assistance provided by NMMRA
Visit QualityNet for more information and documentation on the latest version of CART, including:
Health care providers can use the secure QualityNet Web site to upload CART files and data to the Quality Improvement Organization (QIO) Clinical Warehouse. CART includes several useful report functions. For information on reports available in CART and instructions on running those reports, refer to Chapter 7 of the CART Users' Guide.
Search for your CMS provider ID to see whether your hospital was eligible to receive the full annual payment update. Additional information, regarding data collection and CART (CMS Abstraction & Reporting Tool), data submission, data validation, and vendor communications is available on QualityNet.
| 