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Most hospitals are sending quality data to CMS, but with difficulty

Quality Improvement Monitor, September 17, 2004

Nearly all of the 3,906 inpatient acute care hospitals that are eligible to voluntarily report quality data to CMS under the Medicare Modernization Act have done so. The 3,839 hospitals (98.3% of the total) have met all of CMS' requirements and will receive the full annual payment update from Medicare in 2005.

The 67 hospitals that have not voluntarily reported the data will see a 0.4% reduction in their Medicare fee schedule update in fiscal year 2005, which begins October 1.

CMS will make the hospital quality data available to consumers beginning early in 2005 at its consumer Web site, www.medicare.gov. CMS already publishes the information on its provider website, www.cms.hhs.gov, which is accessible to the public.

Technical difficulties submitting data
About 130 hospitals have experienced technical difficulties trying to electronically submit their data, jeopardizing their ability to receive the full 0.4% update, the American Hospital Association (AHA) reports.

"In many instances, the hospitals we contacted indicated that problems with CMS' CART tool were impeding the successful submission of data on a small number of their patients, despite repeated attempts to get the data into the warehouse," Rick Pollack, AHA's executive vice president wrote in an August 16 letter to CMS Administrator Mark McClellan, MD.

"These hospital leaders are frustrated because they have worked diligently with their QIOs to submit the data so that their information can be shared publicly," Pollack wrote.

"Other hospitals have been confused about what to do if there is a discrepancy between CMS estimates and their actual number of heart attack, heart failure, and pneumonia patients. These hospitals may be experiencing normal fluctuations in the number of patients with each of these diagnoses, or they may have had a change in their medical staff or their market that led to a decrease in patients admitted for these conditions.

"In some cases the QIOs have asked them to write letters explaining their situation. In others, the QIOs asked the hospitals about it and then told the hospitals they would communicate the information to CMS," he stated.

Pollack urged CMS to guarantee that hospitals that have acted in "good faith" to submit their quality data will receive the full market basket update.

"The inability to complete transmission of a small number of problematic data entries, or having fewer cases than CMS thought a hospital would, should not prevent them from receiving the full update," Pollack concluded.

-- Wendy Johnson
wjohnson@hcpro.com

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