Hospitals-Inpatient
The validation review is conducted by the Centers for Medicare & Medicaid Services (CMS) Clinical Data Abstraction Center (CDAC) for selected hospitals participating in the Hospital Inpatient Quality Reporting (IQR) Program. CMS verifies, on a quarterly basis, that hospital abstracted data submitted to the QIO Clinical Warehouse is consistent and reproducible.
Provider Selection
CMS performs a random selection of 800 Inpatient Prospective Payment Systems (IPPS) hospitals on an annual basis. Beginning with Fiscal Year (FY) 2013, all hospitals successfully submitting at least one Inpatient Quality Reporting (IQR) Program case for the third calendar quarter of the 2010 discharges are eligible to be selected for validation. In addition to the 800 hospitals, any hospital selected for validation for the FY 2012 payment determination with a Confidence Interval (CI) calculation less than 75 percent will be validated for the FY 2013 payment determination.
Record Selection
For F Y2013 validation, beginning with discharges on 10/1/2010, when a hospital has submitted fewer than three cases in a topic within a quarter, the stratified sample selection will be modified to randomly reallocate the extra sample cases to other topics with more than three submitted quarterly cases. This is designed to ensure CMS selects 12 cases for all hospitals in a quarter, including those hospitals specializing in only one topic
CMS identifies the universe of abstracted data submitted by each selected hospital, draws a small simple random sample, and has the CDAC re-abstract the clinical measures. The CDAC requests paper copies of the medical records, performs the independent abstraction, and submits the results to the QIO Clinical Warehouse. Hospitals have 45 calendar days from the date of request to deliver the requested medical record to the CDAC.
Validation Rate
Beginning with discharges on 10/1/2009, validation rates are based on measure outcome matches. The Overall Reliability Rate is derived only from the measures required by the Hospital IQR Program. The rate is calculated by dividing the number of measure outcomes that match (numerator) by the total number of Hospital IQR Program required measures (denominator).
A hospital must have 75 percent or higher Overall Reliability Rate to pass the validation for the quarter.
When the Overall Reliability Rate is less than 75 percent, the hospital may elect to appeal the validation results by submitting an appeal to its Quality Improvement Organization (QIO). The case must be eligible for appeal. The appeal must be submitted within 10 (ten) business days from the date the result was posted.
Visit QualityNet for more information on validation.
Contact:
Donna Piatt, RN, Quality Improvement Project Coordinator,
405-302-3212, E-mail Donna Piatt or
Gayla Middlestead, Quality Specialist,
405-302-3241, E-mail Gayla Middlestead