Monday, June 2, 2014

HHS releases new data and tools to increase transparency on hospital utilization and other trends

Data can help improve care coordination and health outcomes for Medicare beneficiaries
With more than 2,000 entrepreneurs, investors, data scientists, researchers, policy experts, government employees and more in attendance, the Department of Health and Human Services (HHS) is releasing new data and launching new initiatives at the annual Health Datapalooza conference in Washington, D.C.
Today, the Centers for Medicare Medicaid Services (CMS) is releasing its first annual update to the Medicare hospital charge data, or information comparing the average amount a hospital bills for services that may be provided in connection with a similar inpatient stay or outpatient visit. CMS is also releasing a suite of other data products and tools aimed to increase transparency about Medicare payments. The data trove on CMS’s website now includes inpatient and outpatient hospital charge data for 2012, and new interactive dashboards for the CMS Chronic Conditions Data Warehouse and geographic variation data. Also today, the Food and Drug Administration (FDA) will launch a new open data initiative. And before the end of the conference, the Office of the National Coordinator for Health Information Technology (ONC) will announce the winners of two data challenges.
“The release of these data sets furthers the administration’s efforts to increase transparency and support data-driven decision making which is essential for health care transformation,” said HHS Secretary Kathleen Sebelius.
“These public data resources provide a better understanding of Medicare utilization, the burden of chronic conditions among beneficiaries and the implications for our health care system and how this varies by where beneficiaries are located,” said Bryan Sivak, HHS chief technology officer. “This information can be used to improve care coordination and health outcomes for Medicare beneficiaries nationwide, and we are looking forward to seeing what the community will do with these releases. Additionally, the openFDA initiative being launched today will for the first time enable a new generation of consumer facing and research applications to embed relevant and timely data in machine-readable, API-based formats."
2012 Inpatient and Outpatient Hospital Charge Data
The data posted today on the CMS website provide the first annual update of the hospital inpatient and outpatient data released by the agency last spring. The data include information comparing the average charges for services that may be provided in connection with the 100 most common Medicare inpatient stays at over 3,000 hospitals in all 50 states and Washington, D.C. Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for those items or services.
With two years of data now available, researchers can begin to look at trends in hospital charges. For example, average charges for medical back problems increased nine percent from $23,000 to $25,000, but the total number of discharges decreased by nearly 7,000 from 2011 to 2012.
In April, ONC launched a challenge – the Code-a-Palooza challenge – calling on developers to create tools that will help patients use the Medicare data to make health care choices. Fifty-six innovators submitted proposals and 10 finalists are presenting their applications during Datapalooza. The winning products will be announced before the end of the conference.
Chronic Conditions Warehouse and Dashboard
CMS recently released new and updated information on chronic conditions among Medicare fee-for-service beneficiaries, including:
  • Geographic data summarized to national, state, county, and hospital referral regions levels for the years 2008-2012;
  • Data for examining disparities among specific Medicare populations, such as beneficiaries with disabilities, dual-eligible beneficiaries, and race/ethnic groups;
  • Data on prevalence, utilization of select Medicare services, and Medicare spending;
  • Interactive dashboards that provide customizable information about Medicare beneficiaries with chronic conditions at state, county, and hospital referral regions levels for 2012; and
  • Chartbooks and maps.
These public data resources support the HHS Initiative on Multiple Chronic Conditions by providing researchers and policymakers a better understanding of the burden of chronic conditions among beneficiaries and the implications for our health care system.
Geographic Variation Dashboard
The Geographic Variation Dashboards present Medicare fee-for-service per-capita spending at the state and county levels in interactive formats. CMS calculated the spending figures in these dashboards using standardized dollars that remove the effects of the geographic adjustments that Medicare makes for many of its payment rates. The dashboards include total standardized per capita spending, as well as standardized per capita spending by type of service. Users can select the indicator and year they want to display. Users can also compare data for a given state or county to the national average. All of the information presented in the dashboards is also available for download from the Geographic Variation Public Use File.
Research Cohort Estimate Tool
CMS also released a new tool that will help researchers and other stakeholders estimate the number of Medicare beneficiaries with certain demographic profiles or health conditions. This tool can assist a variety of stakeholders interested in specific figures on Medicare enrollment. Researchers can also use this tool to estimate the size of their proposed research cohort and the cost of requesting CMS data to support their study.
Digital Privacy Notice Challenge
ONC, with the HHS Office of Civil Rights, will be awarding the winner of the Digital Privacy Notice Challenge during the conference. The winning products will help consumers get notices of privacy practices from their health care providers or health plans directly in their personal health records or from their providers’ patient portals.
The FDA’s new initiative, openFDA, is designed to facilitate easier access to large, important public health datasets collected by the agency. OpenFDA will make FDA’s publicly available data accessible in a structured, computer readable format that will make it possible for technology specialists, such as mobile application creators, web developers, data visualization artists and researchers to quickly search, query, or pull massive amounts of information on an as needed basis. The initiative is the result of extensive research to identify FDA’s publicly available datasets that are often in demand, but traditionally difficult to use. Based on this research, openFDA is beginning with a pilot program involving millions of reports of drug adverse events and medication errors submitted to the FDA from 2004 to 2013. The pilot will later be expanded to include the FDA’s databases on product recalls and product labeling.
For more information about today’s FDA announcement visit:

CMS Advises Delay in ICD-10 Front-End Testing Until October

Providers, suppliers, billing companies and clearinghouses can submit ICD-10 acknowledgement test claims anytime up to the new planned October 1, 2015 ICD-10 implementation date. However, the Centers for Medicare and Medicaid Services is advising stakeholders to delay this front-end testing until after October 6, 2014, when Medicare is scheduled to update its systems.

A May 30 announcement from Niall Brennan, acting director of the CMS Offices of Enterprise Management, recommended that submitters contact their local Medicare Administrative Contractor for additional information about ICD-10 acknowledgment testing, which will allow providers, suppliers, billing companies and clearinghouses the opportunity to determine whether CMS will be able to accept their claims with ICD-10 codes.

In March, Brennan said that CMS successfully conducted a week of ICD-10 testing for more than 127,000 claims that were submitted with ICD-10 codes to the Medicare Fee-for-service claims systems and which received electronic acknowledgements confirming that their claims were accepted. He reported that about 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the test week--representing about five percent of all submitters--and that this testing did not identify any issues with the Medicare FFS claims systems. 

Brennan also informed stakeholders that CMS will be conducting end-to-end ICD-10 testing in 2015. "Details about this testing will be released soon," he said. In May, CMS canceled limited end-to-end testing that had been scheduled for late July, when CMS planned to give a small sample group of providers the opportunity to participate in end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.

The Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date requiring the use of ICD-10 beginning October 1, 2015. The rule will require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015. Last week, CMS announced that the partial code freeze for ICD-9-CM and ICD-10 will continue through October 1, 2015.

(CMS–10340) Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations



This notice sets out a summary of the use and burden associated with the following information collections. More detailed information can be found in each collection’s supporting statement and associated materials (see ADDRESSES).

CMS–10340 Collection of Encounter Data From Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations

CMS–10380 Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program Under the Paperwork Reduction Act (PRA) (44 U.S.C. 3501–3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor.

The term ‘‘collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party.

Section 3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice.

Information Collection

1. Type of Information Collection


Extension of a currently approved collection; Title of Information Collection: Collection of Encounter Data from Medicare Advantage Organizations, Section 1876 Cost HMOS/CMPS, Section 1833 Health Care Prepayment Plans (HCPPS), and Pace Organizations;


CMS collects encounter data or data on each item or service delivered to enrollees of Medicare Advantage (MA) plans offered by MA organizations. MA organizations currently obtain this data from providers. CMS collects this information using standard transaction forms and code sets.

CMS will use the data for determining risk adjustment factors for payment, updating the risk adjustment model, calculating Medicare DSH percentages, Medicare coverage purposes, and quality review and improvement activities.

The data is also used to verify the accuracy and validity of the costs claimed on cost reports.

For PACE organizations, encounter data would serve the same purpose it does related to the MA program and would be submitted in a similar manner.

Form Number: CMS–10340 (OCN: 0938– 1152); Frequency: Weekly; Affected Public: Private sector (business or other for-profits); Number of Respondents: 683; Total Annual Responses: 516,493,635; Total Annual Hours: 34,433 (For policy questions regarding this collection contact Michael Massimini at 410–786–1566).

2. Type of Information Collection

Request: Revision of a currently approved collection; Title of Information Collection: Reporting Requirements for Grants to States for Rate Review Cycle I, Cycle II, Cycle III, and Cycle IV and Effective Rate Review Program; Use: Under the section 1003 of the Affordable Care Act (ACA) (section 2794 of the Public Health Service Act), the Secretary, in conjunction with the states and territories, is required to establish a process for the annual review, beginning with the 2010 plan year, of unreasonable increases in premiums for health insurance coverage.

Section 2794(c) requires the Secretary to establish the Rate Review Grant Program to assist states to implement this provision. In addition, section 2794(c) requires the Rate Review Grant Program to assist states in the establishment and enhancement of ‘‘Data Centers’’ that collect, analyze, and disseminate health care pricing data to the public.

Concurrent with this information collection request, HHS released Cycle IV of the Rate Review Grants, ‘‘Grants to States to Support Health Insurance Rate Review and Increase Transparency in the Pricing of Medical Services.’’ 

The purpose of Cycle IV of the Rate Review Grant Program is to continue the rate review successes of Cycles I, II, and III, as well as to provide greater support to Data Centers, thereby enhancing medical pricing transparency. States and territories that apply for funds are required to complete the grant application. 

States and territories that are awarded funds under this funding opportunity are required to provide the Secretary with rate review data, four quarterly reports, and one annual report per year until the end of the grant period detailing the state’s progression towards a more comprehensive and effective rate review process. A final report is due at the end of the grant period.

This information collection is required for effective monitoring of grantees and to fulfill statutory requirements under section 2794(b)(1)(A) of the ACA that requires grantees, as a condition of receiving a grant authorized under section 2794(c), to report to the Secretary information about premium increases.

On May 23, 2011, CMS published a final rule with comment period (76 FR 29964) to implement the annual review of unreasonable increases in premiums for health insurance coverage called for by section 2794. Under the regulation, if CMS determines that a state has an Effective Rate Review Program in a given market, using the criteria set forth in the rule, CMS will adopt that state’s determinations regarding whether rate increases in that market are unreasonable, provided that the state reports its final determinations to CMS and explains the bases of its determinations.

 The final rule titled ‘‘Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review’’ (78 FR 13406, February 27, 2013) amends the standards under the Effective Rate Review Program. Currently, CMS relies on publicly available information and annual calls with individual states to obtain the information needed to evaluate whether a state has begun to or continues to satisfy the Effective Rate Review Program criteria. CMS is proposing to instead collect the information in writing from all states that would like to request effective status.

Form Number: CMS–10380 (OCN: 0938–1121); Frequency: Annually and On occasion; Affected Public: Public Sector and State and Territory Governments; Number of Respondents: 50; Total Annual Responses: 553; Total Annual Hours: 20,951. (For policy questions regarding this collection contact Susie Lorden at 301–492–4162.)

Dated: May 28, 2014. Martique  Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

NHS staff working together to improve care

Staff are working together to improve care

MORE than 7,650 NHS Wales staff have completed the first level of the national learning programme Improving Quality Together, according to new figures.
The scheme, which provides staff, contractors, managers and board members with skills that will help them improve the care delivered to patients, has been completed at the first level by 7,654 people in the past 15 months.
There are three levels to the programme, launched in March 2013, and it is led by 1,000 Lives Improvement, which is part of Public Health Wales.
Staff complete the bronze level through a series of online modules, with the silver level providing an opportunity to develop and implement improvement projects. The gold level is establishing a network of improvement coaches and there is additional training for board members.
Dr Alan Willson, director of 1,000 Lives Improvement, said: "Improving Quality Together is providing staff with the knowledge and expertise to continue improving our services, so that they are the safest and most efficient they can be.
"We are already seeing the benefits of staff speaking a common language of improvement as they work towards the same goals - improved patient experience and outcomes."
"We are delighted that so many NHS Wales staff have completed at least the bronze level of Improving Quality Together and are looking forward to even more colleagues signing up to the learning programme."
In Aneurin Bevan University Health Board, cleaner operating theatres have lead to safer care under the scheme.
Nurse Helen Dinham used the skills she learnt to reduce surgical site infections, by improving the standard practice of cleaning in orthopaedic theatres in the health board.
Improving Quality Together helped her team address the obstacles that were preventing the correct level of cleaning taking place, such as standardising equipment and amended policies.
The outcome of the project was 100% compliance with the cleaning requirements, meaning infection risks were reduced and patients would recover more quickly.
She said: "Reaching our target was very good for staff morale and has reassured patients that the quality of care and the standard of cleanliness in orthopaedic theatres is excellent."
In ABMU Health Board, they looked at improving patient flow and communication on hospital wards.
Reducing delays in a patient's journey and improving communication on hospital wards are just two of the key benefits gained from Jo Rowland's silver project in the Princess of Wales Hospital, Bridgend.
The assistant head of physiotherapy used her Improving Quality Together training to implement daily ward rounds to discuss each patient and find out the next step needed.
Reporting back findings on a daily basis has increased efficiency and resulted in reduced lengths of stay in hospital and improved patient flow through the wards.
It has also provided a consistent approach, which has improved communication between staff, patients and their families.
Meanwhile, Cardiff and Vale University Health Board has improved access to dental services for patients in prison Head of primary care service delivery Rhian Blake used her silver training to improve access to dental services for patients at Her Majesty's Prison in Cardiff. In the past 18 months the profile of the prison population had changed significantly, with more individuals on remand and shorter sentences.
As a result, many patients had incomplete dental treatment, or didn't receive the required treatment in a timely fashion.
Rhian used the programme's methodology to analyse the problem and find solutions, which included the immediate allocation of appointments when needed, and a quicker triage process. The changes led to a reduction in complaints and fewer missed appointments.