Hospitals are required to provide clinical process quality data reporting to The Centers for Medicaid and Medicare Services (CMS). This requirement serves two purposes; 1) publishing various Quality Indicators for the public to see on www.hospitalcompare.hhs.gov and 2) avoid payment penalties and potentially receive performance bonuses from CMS.
"Monitoring efforts are best focused on leading indicators that allow time for correction, rather than lagging indicators that do not. The best reports for monitoring internal controls contain integrated information from both internal and external sources. Software packages can facilitate pulling together data from disparate systems and processes. "
- David R. Campbell, Accounting Professor at Drexel U - Mary Campbell, Independent Consultant - Gary W. Adams, President of AutoParking, inc. |
Situational Analysis Most hospitals currently utilize manual processes known as "abstraction" that require nurses and support staff to abstract data from various sources, to create a list of patients to be reported per diagnosis (there are currently 29 quality measures that require a report). The second phase of this process is even more complicated and compounded because each patient report requires around 60 data items to meet the quality measure reporting requirements for CMS. This is completed in a backdrop where CMS requirements for reporting can be changed as often as each quarter, and hospitals have limited nurse staff to comply. The situation continues to become more difficult...CMS has indicated that it will require more data and reporting in 2009 (like extending reporting more deeply into Outpatient Care). The Best Practice CMS Quality Reporting Checklist Includes: Is the abstracted patient list that's created for CMS reporting reviewed and validated? Are CMS rules and changes applied on a real-time basis to limit errors discovered after submission? Are reports submitted on a timely basis (within 1 to 2 weeks after discharge)? Is an accurate report filing system created and maintained to provide a timely response to CMS Audits?
| The Solution This "best of breed" CMS Quality Reporting Solution is built on a fully Web Services-enabled composite solutions architecture, comprised of Bluespring Software and Microsoft Office SharePoint Server (MOSS) 2007. It comes pre-configured with "best practice" portals and workflows that address client on-boarding.
Business Value Automation of patient list abstraction for each reported diagnosis grouping Collection of data elements, insertion into report documents and routing to appropriate QI nurse or staff person for completion (reduces amount of time to complete report by 60%-90%). Easy access to CMS Rule Tables for Automatic rule changes across all reporting without using paper and manual communications. Enterprise Document Management & Repository for fast and accurate response to CMS Audits Integration to existing hospital data collection applications such as Biztalk HL7, Ensemble, Tibco, and many others Easy-to-configure Dashboard, complete with KPIs and aggregated information Accurate and timely reporting results in avoiding CMS penalties and potentially garnering payment bonuses! |
