RY2020 MassHealth Acute P4P Technical Session … · 08/08/2019 · EOHHS Medicaid Statewide Hospital Webcast . August 9, 2019 . 11:00am – 12:00 noon (ET) RY2020 MassHealth Acute

EOHHS Medicaid Statewide Hospital Webcast

August 9, 2019

11:00am – 12:00 noon (ET)

RY2020 MassHealth Acute P4P Technical Session

RY20 Webcast Agenda

I. EOHHS Acute RFA20 Quality Requirements

7.1: Program Principles

7.3: Acute Quality Measures

7.4: Performance Assessment Methods

7.5: Incentive Payment Methods

7.6 Submission Requirements & Deadlines

7.2: Hospital Key Rep Requirements

II. RY20 MassQEX Technical UpdatesProcess Measure Specs/ToolsOutcome Measure SpecsMassQEX Portal Reports DisseminationMassQEX User Acct MaintenanceMassQEX Listserv Communication

III. Q & A Period

Wrap-up

Webcast Logistics

Must register to View Slides

WEBEX support line (515) 440-8555

Attendee phone lines are muted during

the session to reduce noise during

webcast.

AVOID putting phones on hold during

Q&A to prevent auto-message noise

during webcast.

Slides posted on Mass.Gov in 3 days:

https://www.mass.gov/service-details/masshealth-quality-exchange-massqex

1 EHS Webcast 8.9.19











EOHHS Medicaid Acute Hospital RFA Contract

Section 7: Quality Reporting Requirements & Payment

Methods

Iris Garcia-Caban, PhD

Hospital Performance Program Lead

MassHealth Office Providers and Pharmacy Programs

EOHHS Medicaid Acute RFA Contract Section 7 Components

Acute P4P Core Principles (Sect.7.1)

Program Aim Reward hospitals for

high quality care and better outcomes forMassHealth patients.

Performance Assessment Each hospital's performance is assessed using methods outlined in the RFA.

Incentive Payments Hospital

payments are contingent on meetingstandards set forth in the RFA.

No Hospitals Exempt All Hospitals

are required to participate in P4PProgram

Sect 7.2 Hospital Key Representatives

Sect 7.3 Quality Performance Measures

Sect 7.4 Performance Assessment Method

Sect 7.5 Incentive Payment Methods

Sect 7.6 Reporting Requirements

EOHHS Technical Specifications Manual (RFA Supplement)


7:3 MassHealth Acute Performance Measures and Goals

EHS Webcast 8.9.19 4

Acute P4P metrics supplement/close gaps in the MassHealth ACO quality strategy Perinatal measures; Health disparities monitoring, Patient Safety/Adverse Events

Support Care integration for better population management Promote joint accountability between Hospitals & PCP on quality and safety

Quality Measure

Category

ID# Measure Name Quality Performance Goals

MAT-4

NEWB-1

Cesarean Birth, NTSV

Exclusive breast milk feeding

Reduce morbidity, added LOS for

mom/newborns

CCM-1

CCM-2

CCM-3

Reconciled medication list rcvd by D/C patient

Transition record with specified data elements rcvd by D/C patient

Timely transmission of transition record within 48 hours at D/C

Ensure safe & effective hand-offs

at time of D/C

to avoid readmissions

HD-2 Health Disparities Composite Reduce disparity in care process

PSI-90

HAI-1

HAI-2

HAI-3

HAI-4

HAI-5

Patient Safety & Adverse Events Composite (PSI-3,6,8,9,10,11,12,13,14,15)

Central Line-Associated Bloodstream Infection

Catheter-Associated Urinary Tract Infection

Methicillin-Resistant Staphylococcus Aureus bacteremia

Clostridium Difficile Infection

Surgical Site Infections: Colon/Abdominal hysterectomy

Reduce Preventable

Complications & Occurrence of

Harm

HCAHPS Hospital Consumer Assessment of Healthcare Provider Systems

Survey (7 dimensions: Nurse Communication, Dr. Communication,

Communication about Meds, Responsiveness of Hospital Staff,

Discharge Information, Overall Rating, CTM-3)

Improve

Patient-Centered Care

7.3: Acute Measures Data Completeness Requirement

Data Completeness -- refers to whether or not all the necessary elements required toconduct performance evaluation are available in the data sources collected.

Incomplete data refers to data that is selectively collected or excluded in reported data files

Measure Type EOHHS Data Collection

Data Completeness Requirement

Chart-based (MAT, NEWB, CCM)

Hospital reported (all Medicaid payer data)

Submit data files of sample cases that meet IPP; and Enter ICD population/sample count data; and Meet submission deadlines; and Submit charts for validation

Claims-based* (PSI-90)

MMIS paid claims* (all Medicaid payer data)

Contain all clinical and administrative codes requiredby AHRQ software (POA, ICD, age, admission type, etc.)

National Registry-based* (HAI’s)

MassHealth NHSN Group * (all Payer data)

Meet NHSN data reporting specs/deadlines

Adhere to NHSN Monthly Report Plans

Meet CMS reporting deadlines

National Survey-based* (HCAHPS)

Hospital Compare Website (all Payer data)

Meet HCAHPS reporting guidelines

Meet CMS reporting deadlines

5

asterisk (*)= No data reporting to MassHealth is required

All Medicaid payer = all members where MassHealth is primary payer.

EHS Webcast 8.9.19

7.4: RY20 Acute Measures Calculation Criteria


Quality Measure Category Data Completeness

Requirement

Case Minimum Insufficient Data

PROCESS MEASURES

(Rates or ratio)

Pass Validation

Meet 5 criteria (slide #5)

Each Metric: Must Have 25cases/year.

Has <25 cases/year

HD-2 COMPOSITE

(BGV value)

Pass Validation Have 25 cases/year inhospital reference group and

Have >1 racial group in data

Has <25 cases/year in reference group Has <2 racial groups

PSI-90 COMPOSITE

(Index Value)

Claims file with all clinical& admin data field values

Have 3 cases for one of theten indicators (computed byAHRQ software)

Has <3 cases for all ten indicators Zero cases met denominator criteria

HEALTHCARE-

ASSOCIATED INFECTION

(SIR values)

Meet NHSN Monthly

Report Plan

Meet NHSN reporting

guidelines

Have at least 12 mos. of HAIdata

Have SIR number is 1.0

if predicted # of HAIs is <1.0 if Hospital submits No Data to NHSN CLABSI No NHSN mapped wards CAUTI No NHSN mapped wards CDI if community-onset prevalence

rates are w/in outlier bounds SSI total COL/HYST <9 in prior CY

HCAHPS SURVEY

DIMENSION

(Rates)

Meet HCAHPS QualityAssurance Guidelines

At least 100 completedsurveys in CY period

<100 surveys completed in CY period

NOTE:

If Hospital attests to measures exemption but data is received or obtained by MassHealth then all

eligible metrics data will be computed using above criteria.

Refer to EOHHS Tech Specs Manual for more detail that apply to calculation criteria.

7.4: Data Validation Requirements for Process Measures

Data Reliability Standard

Impacts Perinatal, Care coordination & Health Disparity QMC’s

Purpose data validation – verify that hospital reported patient-level data is

accurate and reliable for performance scoring.

In RY20, Hospitals must meet data validation standard (.80) on three

quarters of submitted data files

Quality Scoring Impact

Passing Validation is required prior to computing hospital performance

scores

If FAIL validation in comparison year (RY20) for reported measures then all

process measures data is considered unreliable for performance scoring.

If FAILED validation in prior year (RY19) then data is considered invalid for

computing comparative year performance.


7.4: Overview of Performance Assessment Methods

Performance Scoring Criteria Must Pass data validation (process measures only) Meet data completeness requirements (all measures) Meet Case minimum for (all measures) Have sufficient data (see slide #6)

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Perinatal Care Measure Rates Attainment & Improvement Attainment: Median (50th)

Benchmark: Mean top decile (90th)

Lower is better (MAT4)

Higher is better (NEWB1)

Care

Coordination

Measure Rates Attainment & Improvement Attainment: Median (50th)


Higher is better

Health Disparity BGV value Decile Rank Target Attainment

(above 2nd decile )

Lower is better

Safety Outcomes

PSI-90 Composite

Five HAI’s

Index value z-score

Interquartile Rank

(of overall z-score)

Minimum Attainment

(above 1st quartile)

Lower is better

S.I.R value z-scores

Patient Experience/

Engagement

Measure Rates Attainment & Improvement Attainment: Median (50th)


Higher is better

EHS Webcast 8.9.19

7.4: Attainment & Improvement Performance Assessment Approach

Attainment Threshold

• Represents minimum

level of performance

required to earn points

• Set at Median (50th) of

all hospital prior year

data.

Benchmark Threshold

• Represents highest

performance achieved to

earn maximum points

• Set at Mean of top

decile (90th) of all

hospital prior year data

Improvement

• Represents progress

achieved from prior year

to earn points

• Individual hospital

results is better than

prior year

Evaluates each Hospital's result compared to all Hospitals

Evaluates each Hospital's Previous & Comparison Year

Rates plus

All Hospitals Individual Hospital


7.4: Process Measure Categories: Attainment & Improvement Scoring

STEP 2 Quality Points Criteria

Must Pass Data Validation

Must have 25 cases/year for each measure tocompute quality score (NEW)

Attainment Pts if NO cases in baseline periodmay be eligible for attainment pts if pass datavalidation in comparison period

Improvement Pts Awarded when havebaseline & comparison period data

Awarded Points: Get higher of Attainment orImprovement points (after has establishedbaseline measure result)

10

(Current Measure Rate – Prior Yr. Rate) x10 – 0.5 = Improvement Pts

(Benchmark Threshold – Prior Yr. Rate)

Total Awarded Points x 100 = Total Performance Score

Total Possible Points

(Hospital Measure Rate – Attainment) x 9+0.5 = Attainment Pts.

(Benchmark – Attainment)

Step 5

STEP 1 Quality Point System

ATTAINMENT POINTS 0 points: If rate attainment

1 to 9 points: If rate > attainment but < benchmark

10 points: If rate ≥ benchmark

IMPROVEMENT POINTS 0 points: If rate previous year

0 – 9 points: If rate between previous year & benchmark

Step 3

Step 4

EHS Webcast 8.9.19

7.4: Health Disparity Category Performance Scoring Method

BGV

Performance

Threshold

Decile

Group

Conversion

Factor

10th decile 1.0

9th decile .90

8th decile .80

7th decile .70

6th decile .60

5th decile .50

4th decile .40

Target Attainment 3rd decile .30

Lower Deciles 2nd decile 1st decile

0 (zero)

HD2 Performance Score =

Conversion Factor x 100%

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Description

Composite Pull racial groups from MAT, NEWB, & CCM

reported data

Step 1:

Compute Results

Racial Comparison Group Rate

Hospital Reference Group Rate

HD2 Composite Value = BGV (variation in care)

Step 2:

Set Threshold

BGV Target Attainment set above 2nd decile

Step 3:

Decile Rank

All Hospital BGV’s are ranked highest to lowest

Step 4:

Conversion Factor

A weight is assigned to each decile group

Step 5:

Compute Score

Health Disparity Performance Score = Conversion

Factor x 100%

Performance

Scoring

Criteria

Must pass data validation for process measures

Hospitals data must have >1 Racial group to be

scored

Must have 25 cases in Hospital Reference

Group denominator (NEW)

EHS Webcast 8.9.19

7.4: Patient Experience Category Performance Scoring Method

Step 1 Attainment & Improvement Method

HCAHPS Measures (n=7 dimensions)

Performance Thresholds: Attainment

and Benchmarks use all hospital prior

year reported HCAHPS state-level data

obtained from CMS Hospital Compare

Step 2 Quality Points Criteria Case Minimum: have at least 100

surveys in baseline & comparison period

Improvement Pts Must have both

previous & comparison year data

Awarding Points: quality points are

awarded when hospital has already

established a baseline rate

Steps 3 - 6 Performance Scoring Process

Step 3 Use Quality Pts System: for

each survey dimension (see slide #10).

Step 4: Use Attainment Pts Formula

Step 5 Use Improvement Pts formula

Step 6 Compute Total Performance

Score using below formula:

Total Awarded Points x 100 = Patient Experience Total

Total Possible Points Performance Score

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(Hospital Measure Rate – Attainment) x 9+0.5 = Attainment Pts.

(Benchmark – Attainment)

(Current Measure Rate – Prior Yr. Rate) x10 – 0.5 = Improvement Pts

(Benchmark Threshold – Prior Yr. Rate)

EHS Webcast 8.9.19

7.4: Safety Outcomes Category Performance Scoring (1of 4)

Safety Outcome Measures

Include Six Measures

1. PSI-90 Index Value

2. CAUTI SIR value

3. CLABSI SIR value

4. MRSA SIR value

5. C. Difficile SIR value

6. Surgical Site Infections SIR value

SOM Quality Scoring Criteria PSI-90 Must have 3 cases for

one of 10 indicators for quality scoring

HAI’s Each HAI must have sufficient data to be eligible for quality scoring

SOM Category

Performance Scoring Steps

• Step 1: Compute Winsor Measure Result

for each measure

• Step 2: Compute Winsorized z-score for

each measure

• Step 3: Apply weights to each measures

Winsor z-score

• Step 4: Compute overall safety z-score for

each Hospital

• Step 5: Rank Hospitals overall z-score to

identify worst performing quartile.


7.4: Safety Outcomes Performance Assessment (2 of 4)

Step 1: Compute Winsorized Measure Result

Each measures winsorized result is obtained

by creating a continuous rank distribution of

all eligible hospital raw values that are

truncated at the 5th and 95th percentiles.

Each Hospital's raw measure value in

the distribution is determined as follows:

If falls between minimum value and 5th

percentile then it is equal to 5th percentile

If falls between 95th percentile and

maximum then it is equal to 95th

percentile

If falls between 5th and 95th percentile

then it is equal to the Hospital’s raw

result.

Step 2: Compute Winsorized Z-score

A Winsor Z-score (Zi) is calculated for each hospital measure as the difference between the Hospital's Winsorized measure result (Xi) and the mean of Winsor measure results across all eligible hospitals (X ) divided by the standard deviation of the Winsorized measure result from all eligible hospitals' data using the following formula

• The Hospital's winsor z-score for each safety measure reflects how many standard deviations each value is away from the Mean measure result.

Measure Zi score = (Xi) – (𝐗 )

SD (xi)


7.4: RY20 Change to SOM Category Weights Methodology (3 of 4)

Step 4:

Compute Overall Safety Z-Score

Assign weight to each measure z-score

Multiply the measure z-score by the weight shown on table (left).

When hospital has no z-scores for any measure it will not get an overall safety score.

Overall Safety score reflects the sum of all contributions of the measure z-scores.

The SOM category overall z-score is computed based on the formula below:

Step 3:

Compute SOM Weights

In RY20 replace two component weights (60/40%) approach with Equal Measure Weights (EMW).

This approach factors in hospitals that have less than 5 HAI results in NHSN dbase.

The Hospital’s overall safety z-score is represents the weighted average of all available z-scores.

15

(𝑃𝑆𝐼90 𝑧𝑠𝑐𝑜𝑟𝑒 + 𝐻𝐴𝐼 𝑧𝑠𝑐𝑜𝑟𝑒𝑖)𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐻𝐴𝐼𝑖=1 (𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝐻𝐴𝐼 + 1)

EHS Webcast 8.9.19

Number of measures

with a z-score

Weight assigned to each

measure z-score

6 16.7

5 20.0

4 25.0

3 33.3

2 50.0

1 100.0

0 N/A

7.4: Safety Outcomes Performance Assessment (4 of 4)

Step 5:

SOM Performance Ranking

Interquartile Rank Method. Each hospital's overall safety z-score results are ranked from highest to lowest across four equal groups.

Minimum Attainment Threshold.

Reflects the minimum level of

performance that must be achieved to

earn incentive payments

Lower overall z-score indicates better

performance

Higher overall safety z-score indicates

worse performance

RY20 Minimum Threshold

• Hospital overall z-scores that are

above 1st quartile will get incentive

payments

• As of RY20 Hospital overall z-scores

that fall on 1st quartile (worst

performing) will get no incentive

payments.

Interquartile

Range

Quartile

Group

Conversion

Factor

Top Quartile

(lower z-score)

4th Quartile 1.0

3rd Quartile .75

2nd Quartile .50

Lower Quartile

(higher z-score)

1th Quartile zero


7.4: RY20 Performance Evaluation Data Periods

PSI-90 & HAI metrics more current data periods PSI-90 overlap data periods are under consideration for subsequent rate years.

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Quality Measures Categories

Previous Year Data Period

Comparison Year Data Period

Perinatal Care July 1, 2018 – Dec 31, 2018 Jan.1, 2019 – Dec 31, 2019

Care Coordination July 1, 2018 – Dec 31, 2018 Jan.1, 2019 – Dec 31, 2019

Health Disparities Not Applicable Jan.1, 2019 – Dec 31, 2019

Patient Safety and Adverse

Events Composite (PSI-90) Not Applicable Oct 1, 2016 – Sept. 30, 2018

(24 months)

Healthcare-Associated

Infections (HAI’s) Not Applicable Jan 1, 2017 – Dec 31, 2018

(24 months)

Patient Experience Jan 1, 2017 – Dec 31, 2017 Jan 1, 2018 – Dec 31, 2018

EHS Webcast 8.9.19

7.5: MassHealth Incentive Payment Methods

Payment Eligibility Criteria Meet Data Completeness Requirement

Meet Data Validation Standard

Achieve Performance Thresholds

Incentive Payment Components Maximum Allocated Amt.: overall dollars tied to achieving performance

Statewide Eligible Medicaid Discharges: all hospital discharges for measure population

QMC per Discharge Amt.: estimated amount by quality measure category

Incentive Payment Formula Final Performance Score: Computed for each QMC

QMC per-discharge Amount: Final computed from FY19 eligible discharges

Eligible Discharges for each QMC: Final computed from FY19 discharges


Maximum Allocated Amount = Quality Measure Category per

Discharge Amount Statewide Eligible Medicaid Discharges

Final Performance Score) x

(Eligible Medicaid Discharges) x

(QMC per Discharge Amount)

= Hospital Incentive Payment

7.5: RY20 Eligible Medicaid Discharge Data (MDD) Volume

Definition of Terms

Identifying MDD Volume

Meet ICD/DRG measure requirement

MassHealth is primary & only payer source

Members covered under RFA payments

(FFS Network + PCCP + ACO-B Plans)

MMIS Paid Claims Extract

Included : Adjudicated Payment Amount per

Discharge (APAD) is an all-inclusive facility

payment for an acute inpatient hospitalization

from admission to discharge,

Excluded: Per Diem payments (Transfer,

Psych, Rehab); Admin days, Interim bills, and

outlier payments

MDD Period: Use FY19 10/1/18 – 9/30/19

discharges to compute RY20 P4P payments.

Identifying MDD by QMC

Included Claim

QMC Inpatient Measure Population

Perinatal

Care

• Meet ICD population in TJC code tables

• Mothers age ≥ 8 and 65 years

• Newborn age ≥ 0 and 2 days

Care

Coordination

Meet ICD population in EHS Manual.

Age > 2years and 65 years

Health

Disparity

Unique Discharges that meet ICD

requirement for at least one or more

process measures hospital reported on

(counted only once).

Safety

Outcomes

Meet APR-DRG medical & surgical

population codes

Age ≥ 18 years of age

Patient

Experience

Meet APR-DRG medical, surgical,

vaginal & cesarean population codes

Age ≥ 18 and 65 years


7.6: RY20 Quality Reporting Requirements & Timelines

Submission

Due Date

Data Submission

Requirement

Data Reporting

Format

Reporting

Instructions October 1, 2019 Hospital Quality Contacts Form

Hospital Data Accuracy and

Completeness Attestation Form

HospContact_2020 Form

HospDACA_2020 Form

RFA Section 7.2.D

RFA Section 7.3.D

November 15, 2019 Q2-2019 (Apr – June 2019) data

Q2-2019 ICD population data

Q2-2019 Medical records request*

Electronic Data Files; and

ICD online data entry form (via

MassQEX Portal)

Technical Specifications

Manual (Version 12.0,

12.1)

February 14, 2020 Q3-2019 (July – Sept 2019) data




ICD online data entry form

(via MassQEX Portal)


Manual (Version 13.0)

May 15, 2020 Q4-2019 (Oct – Dec 2019) data


No records required for Q4





Manual (Version 13.0)

August 14,2020 Q1-2020 (Jan – Mar 2020) data







Manual (Version TBD)

20

Reporting Reinstate quarter reporting cycles (as of Aug 2019) & announce RY21 rolling Q1 reporting NEW Table Insert –Medical Records Qtr. cycle reminder (upon MassQEX request) Hospital must comply with HAI data reporting timelines required by NHSN and CMS Hospital must comply with HCAHPS data reporting timelines required by CMS. Program Participant Forms due (see next slide)

EHS Webcast 8.9.19

MassHealth Program Participant Forms

(RFA section 7.6)

Hospital Quality Contact Form (Revised)

List Two Key Representatives

List NHSN contact

Expand Hospital User Limit (n=5 )

Identify Vendor Users (n=3)

Hospital Data Attestation Form (Revised)

Must Complete Measures Exemption table (perinatal, CLABSI, CAUT, SSI, & HCAHPS)

Mailing Hard Copy Forms Iris Garcia-Caban, PhD MassHealth Acute Hospital P4P Program 100 Hancock St. 6th floor Quincy, MA 02171

Hospital Representative Requirements

(RFA section 7.2)

EOHHS requires Two Key Reps (Quality & Finance) be designated for all business correspondence on Acute RFA Section 7 requirements.

Only Key Reps are entered in EHS email & mailing databases.

New provision – Key Quality staff required to access annual measure result reports and chart case listing via the MassQEX secure portal.

Recommend Key Quality Rep open portal user account to access year-end reports.

21

Forms on Mass.Gov at: http://www.mass.gov/eohhs/provider/insurance/masshealth/massqex/

EHS Webcast 8.9.19

7.6 RY20 MassHealth Program Participant Forms

http://www.mass.gov/eohhs/provider/insurance/masshealth/massqex/

Summary of Changes to RY20 MassHealth Acute P4P Program

Acute RFA20 Contract Section 7

7.2: Key Representatives (provision)

7.3: Modify Quality Category Name

Rename OB/NEW to Perinatal Care

Reframe Safety Outcome Measures

7.4: Performance Scoring Methods

Case minimum (process measures)

Change SOM weights method

Implement SOM minimum threshold

7.6: Reporting Requirements

Submit 4 Quarters data

P4P Program Forms (Revised)

Other Important Updates

EOHHS Tech Specs Manual (v13.0)

Reorganize Core Manual sections

Update Appendix Tools

MassQEX Year-end Reports (New)

Portal Dissemination Method

MassQEX Reports User Guide

EOHHS Payment Reports

Continue Mailing Method

Payment Report User Guide (New)


MassHealth Acute P4P Program Considerations for RY2021

• Care Coordination Measure Set Final Phase-in of CCM-2 transition record counter to N=11

Work with Hospitals to improve metric specifications

• Modify SOM Category Performance Assessment Approach

• Enhance MassQEX Portal Reports Dissemination

• Candidate Measures for Consideration

– Perinatal Care Measures • Unexpected complications in Term Newborns (NQF #716)

• Episiotomy measure (NQF# 0470)

– Identify surgical measures

– Identify safety measures (opioid medications, etc.)


RY2020 MassHealth Quality Exchange (MassQEX)

Technical Updates

Cynthia Sacco, MD

Medical Director Health Management

Telligen, Inc.

RY2020 Key Changes to Technical Specifications

Measures Collection & Reporting Updates

• Process Metrics Specs • Data Reporting Specs

• Appendix Tool Updates

• Medicaid CHIA Payer Codes

• Chart Validation

• Safety Outcome Metrics Specs • PSI-90 criteria & reports

• HAI criteria & reports

• Patient Experience Metric Specs • HCAHPS calculation criteria

• HCAHPS reports

MassQEX Portal Reports Dissemination (NEW)

• All MassQEX Report Formats (Revised)

• Portal Dissemination Procedure (RY19 vs. RY20)

• RY20 Case List Request (downloads)

• User Account Limits

• User Account Maintenance and Responsibility


RY2020 Updates to Process Measure Data Reporting Specifications (Effective Q3-2019)

Measure Description & Flowchart (Section 3)

MassHealth Data Dictionary Updates

(Appendix A-6)

Hospital & Vendor Data Tools/XML (Appendix A- 1,2,3,4,7)

All Charts • No change • Discharge Disposition • No change

MAT-4 • Previous Live Births replaces Number of Previous Live Births

• Previous Live Births • Updated to Previous Live Births with allowable values of Yes/No

• ICD Code Tables consistent with applicable version TJC specifications

NEWB-1 • Term Newborn • Term Newborn • Term Newborn updated with allowable values of 1, 2, or 3

• ICD Code Tables consistent with applicable version TJC specifications

CCM-1 • No change • Reconciled Medication List • No change

CCM-2 • Updated scoring counter logic

• No change • No change

CCM-3 • No change • No change • No change

EOHHS Technical Specs Manual (v13.0) will provide more detail.


RY20 MassQEX Medicaid Payer Source Data Collection

CHIA Medicaid Payer Source (Process Measures)

Hospitals required to collect MAT4, NEWB1 and CCM cases where MassHealth is primary or only payer source.

MassHealth adapts CHIA Medicaid Payer source codes already used for CHIA hospital case mix reporting

EOHHS Tech Specs (v13.0) lists CHIA included/excluded managed care (ACO, MCO) and FFS plan codes.

Minor corrections in v13.0 payer code table were made from v12.0 and 12.1

MMIS Claims Payer Source

(PSI-90 Measure)

• PSI-90 measure payer source data is extracted using revenue codes from following sources

• MMIS Revenue Codes: hospital FFS billing discharges where MassHealth is only payment source for members in FFS, PCCP, Primary Care ACO Plans.

• MMIS Encounter Data Revenue Codes: hospital billing discharges where MassHealth is only payment source for members in ACO and MCO plans.

• MMIS claims revenue codes are not the same CHIA Medicaid payer codes.


RY2020 MassQEX Portal CCM-2 Transition Counter Phase-In

Effective Q1-2019 file submissions The MassQEX portal transition record

counter for CCM-2 is modified to meet the measure if >= 8 data elements were present on the Transition Record given the patient.

No Hospital Action Required • No change to CCM2 abstraction tools (all

data elements already abstracted).

• No change to XML tools or file uploads.

• Only the MassQEX portal software is updated to compute >=8 threshold.

NOTE -- Portal transition counter does not correlate with a performance score.

Excerpt from the CCM 2 Measure Algorithm to be published in the EOHHS Technical

Specifications Manual v13.0

Transition

Record Counter

Primary Physician/

Health Care

Professional Designated

for Follow Up Care?

Yes

Missing

X

Add 1 to Transition Record Counter

No

D

E

Stop

> = 8

< 8


RY2020 Process Measures Data Validation Requirements

Total Charts Sampled = 12 records for first three quarter discharge periods

MassQEX request N=4 charts for each quarter (Q1, Q2, Q3-2019)

Medical records must be submitted within 21 calendar days from date of request

Validation Result calculated as the total scored items in agreement / total scored items rated

Must pass validation (.80) based on UCL

Scored Data Elements (New Table 6.1)

Scored Data Elements Non-Scored Data Elements

NEWB-1 Measure: Admission to the NICU, Discharge Disposition,

Exclusive Breast Milk Feeding, Term Newborn, Race, Hispanic Indicator

MAT-4 Measure: Gestational Age, Previous Live Birth, Race, Hispanic

Indicator

CCM Measures: Discharge Disposition, Reconciled Medication List,

Transition Record, Advance Care Plan, Contact Information 24 hours/ 7

days, Contract Information for Studies Pending, Current Medication List,

Discharge Diagnosis, Medical Procedures and Tests, Patient

Instructions, Plan for Follow-up Care, Primary Physician/ Healthcare

Professional for Follow-up Care, Reason for Admission, Studies

Pending at Discharge, Transmission Date, Discharge Date, Race,

Hispanic Indicator

Admission Date

Admission Time

Birth date

Discharge Date (scored for CCM-3 only)

Discharge Disposition (scored for NEWB-1 and

CCM only)

Episode of Care

First Name

Hospital Patient ID #

ICD-CM Diagnosis Codes

ICD-PCS Procedure Codes

Last Name

Member ID Number

Payer Source

Provider ID

Provider Name

Sex


RY2020 MassQEX PSI-90 Measure Calculation

Data Completeness: exclude discharges with incomplete, partial or missing/invalid data in

clinical and administrative data fields.

Case Minimum: hospital data must have 3 cases for at least one indicator in data period

Data Transformation: MassQEX will transform PSI-90 index results to Winsorized Z-score to

reduce effect of outliers and standardize result.

MassQEX PSI 90 Report Illustration


RY2020 Healthcare-Associated Infection Measures Calculation

Data Completeness: All hospital HAI measure data submitted to NHSN is compared to the

hospital’s MassHealth DACA Form measures exemption request.

Case minimum: SIRs are not generated in NHSN if the number of predicted infections is less

than 1.0.

Data Transformation: MassQEX will transform HAI results to Winsorized Z-score to reduce

effect of outliers and standardize result.

MassQEX HAI Report Illustration


RY2020 Patient Experience HCAHPS Measure

MassQEX Data Collection

The Hospital’s “Top Box result” on HCAHPS surveydimension will be obtained from HospitalCompare.

Hospitals must meet the minimum threshold forsurvey responses to be eligible for this measure

MassQEX Calculation

“Top Box” results are percentages with highestresponse on survey scale for each HCAHPSsurvey dimension

The Top Box result is displayed as an “AnswerPercent” for each dimension

32

MassQEX HCAHPS Report Illustration

EHS Webcast 8.9.19

MassQEX Annual Reports Portal Dissemination (NEW)

MassQEX Year End Reports willno longer be mailed to Qualityand RFA Contact at eachhospital

Year-End Reports will be postedin the MassQEX portal

Hospitals will be able to accessand manage their reports viasecure portal

Time sensitive reports must beaccessed by the HospitalQuality Contact and MassQEXHospital User Staff

MassQEX List Serv Messageswill notify users of posting date

Types of MassQEX Reports to be posted

• Reports #1-8 in PDF format (some contain PHI)

• Reports # 9 & 10 in webpage HTML format (not fordownload)

MassQEX Report Name Description

1. Medical Record Case List Record Request for Q1,Q2, Q3 validation

2. Year End Data Validation Results Overall validation result (pass/fail status)

3. Year End Validation Record Detail Case level outcome for each validation record

4. Validation Data Element

Comments Educational comments on data mismatches

5. Year End Measure Results Overall and quarterly rates for very measure

6. Year End Health Disparity Results Display of racial group and BGV results

7. Safety Outcome Measure Results Display PSI 90 and HAI measures results

8. HCAHPS Measure Results Display of survey dimension results

9. HD-2 Drill-Down Case level detail on missed opportunity

10. PSI 90 Drill-Down Case level detail on the numerator event


MassQEX Portal Reports Dissemination Screenshot

Access to Portal Annual Reports

*Hospital Users will only be provided access to reports in secure portal for the hospital linked to user account.

Step 1: Go to portal homepage. Under Account Log-in, enter User name and password.

Step 2: Under “Getting Started” header select “MassQEX Year-End Reports” link.

Step 3: Select the rate year from the drop down, then click on “List Reports”. The hospital specific MassQEX Year-End Reports page will display.

Step 4: Links to available reports will display. Click on any report link and an acknowledgement message will display.

Step 5: You must select Ok to download the report. The PDF file for the report will load and display at the bottom left of your screen.


RY20 MassQEX Portal Case List Requirements

END PAPER MAILING The Medical Record Case List requests will no longer

be mailed to the Key Quality Contact and Director of Medical Records at each

hospital.

MassQEX User Requirement The Case List must be accessed by the

Hospital staff user authorized to have an account by the hospital CEO. Portal

audits are conducted to monitor for compliance.

TIME SENSITIVE REQUEST The Hospital Quality Contact is responsible for

coordinating request and ensuring the requested record list is provided to

HIM/medical records dept. staff.

MASSQEX NOTICES Listserv messages will be sent to all active MassQEX

portal users.

As of Q3-2019 submissions cycle (Feb. 2020) the Medical Record Case List must be accessed via MassQEX Portal


MassQEX Annual Reports User Guide

Purpose of User Guide

Replaces cover letters in previously mailed reports and expands detail on how to read each rate year specific reports.

The RY20 MassQEX Reports User Guide will be a new Appendix A-9 in RY20 EOHHS Technical Specifications (v13.0).

RY20 MassQEX Reports User Guides are posted one month prior to posted reports.

The RY19 MassQEX User Guide will be a EOHHS Release Notes (v12.2) related to RY19 EOHHS Tech Specs Manual (12.0).

User Guide Contents

o Section 1: Introduction (Measure data periods, Types of reports, How to access reports)

o Section 2: Report descriptions including field definitions

o Section 3: Interpreting report content

Contact MassQEX Help Desk at

[email protected] or 844-546-

1343 with questions


mailto:[email protected]

Phase-In of MassQEX Annual Reports Posting to Portal

Rate Year Report Type Portal Posting Timeline

RY2019 RY19 MassQEX Report User Guide December 2019 (Tech Specs Release Note v12.2)

Year-End Validation Results December 2019

Year-End Measure Results (all Process and Outcome Reports)

December 2019

RY2020 RY20 MassQEX Report User Guide TBD

Case List Q3-2019 Discharges February 2020

Year-End Validation Results September 2020

Year-End Measure Results (all Process and Outcome Reports)

December 2020

IMPORTANT NOTE: Case list medical record submissions are time sensitive. No extensions beyond due date to be granted. The timeline for submission of records is 21 days from notification. Access of the case list will be monitored.

A MassQEX Listserv notice will alert all Users when Case List is posted.


MassQEX Hospital User Account Maintenance

RY20 Portal User Accounts Hospital Staff User Limit: Expand to N=5 Accts (facilitate access to Annual reports)

Data Vendor User Limit: total of N=3 accounts

EOHHS periodically monitors all Hospital User Accounts by comparing MassHealthHospital Quality Contact Forms against MassQEX active accounts profiles.

MassQEX User Activity Monitoring Inactive Accounts: If the account has no activity within 90 day period, it will be closed

and a new MassQEX registration must be submitted.

Disabled Accounts: If accounts are locked after 3 failed log-in attempts. User mustcontact the MassQEX Helpdesk to reset the account.

Unusual Account Activity: access of the portal user accounts by any individual otherthan the one authorized by the Hospital CEO are automatically disabled and suspended.

Go to Section 5 of EHS Tech Specs manual for more detail.


MassQEX List Serve Communication

Purpose MassQEX list serv notifications are for program announcementsgenerally related to data submission and reporting timelines

Standard messages - Portal Open/Close Notification, ICD populationreminder, User account maintenance, other technical updates, etc.

New- Notification of availability of reports in the MassQEX portal

Registered Users are auto-enrolled for MassQEX list serv communication.

Hospitals must update All User Accounts to ensure receipt of listservnotifications.

Other non-users can be added to listserv by contacting MassQEX Helpdesk:

Phone: 844-546-1343 (toll free #)

Email: [email protected]



Wrap Up

EOHHS Medicaid Acute RFA20 P4P Requirements Iris Garcia-Caban, PhD, Phone: (617) 847–6528

EOHHS Business Mailbox: [email protected]

Program Resources: https://www.mass.gov/masshealth-quality-exchange-massqex

MassQEX Customer Support Phone: 844-546-1343 (toll free #)

Email: [email protected]

Technical support (measure abstraction; portal specs)

Create MassQEX User Accounts; Enlist for MassQEX Listserv



https://www.mass.gov/masshealth-quality-exchange-massqex









Documents

RY2020 MassHealth Acute P4P Technical Session … · 08/08/2019 · EOHHS Medicaid Statewide Hospital Webcast . August 9, 2019 . 11:00am – 12:00 noon (ET) RY2020 MassHealth Acute