Administrative Memos

200406

FROM: Theodore O. Will, Chief Executive Officer
DATE: May 24, 2004
SUBJECT: Validation Studies
IPRO CONTACTS:

Karen O'Leary, Performance Improvement Coordinator, extension 124

As part of the 7th Scope of Work activity and in support of the public reporting initiatives, the Centers for Medicare and Medicaid Services (CMS) is conducting a quarterly retrospective validation of data submitted by hospitals to the QIO Clinical Warehouse. The purpose of this memorandum is to provide you with information about the validation studies process and identify additional sources of information that are available to you.

Overview

The validation process is a chart audit performed to ensure that the data submitted to the QIO Clinical Warehouse accurately reflects the care and services recorded in the respective patients' medical records. If a hospital has transmitted a minimum of six (6) discharges to the Warehouse across any of the four clinical topics (AMI, HF, PNE or SIP) for a discharge quarter, the hospital is eligible for validation studies. Five (5) medical records across the four topics will be selected at random for re-abstraction. CMS has contracted with AdvanceMed Corporation, the Clinical Data Abstraction Center (CDAC) for the East Coast region, to perform the re-abstraction. The CDAC will request copies of the five medical records from each eligible hospital to perform the re-abstraction and to identify any discrepancies. Each hospital will receive a summary report of the validation results from the CDAC. IPRO's role is to provide hospitals with assistance, feedback and education, especially in cases in which the hospital's data did not meet the 80% validation threshold, i.e. where the data from the CDAC abstractions agree with the data submitted by the hospital on less than 80% key data elements across the five cases. Hospitals who fall below an 80% validation rate will have an opportunity to appeal the CDAC finding. IPRO will work with hospitals that initiate appeals to facilitate the process.

Handling Record Requests

Some records selected for validation do not contain the traditional patient identifier information in the Patient ID field, resulting in providers being unable to identify the patient when the medical record is requested by the CDAC. This is usually due to the encryption process your JCAHO ORYX PMS vendor uses to submit your discharge data to the QIO Clinical Warehouse. CMS has instructed your JCAHO ORYX PMS vendors on how to submit data to the Warehouse so that future transmissions include the appropriate patient identifiers. In the event that you receive CDAC requests for records for which the traditional patient identifiers are not present, you should contact your JCAHO ORYX PMS vendor with the information listed on your CDAC request. Your vendor will utilize the case ID on the request to obtain the necessary identifiers for you. Please do not contact the CDAC for patient identifying information as they will not be able to supply it to you.

When sending records to the CDAC, please be sure to follow all the instructions provided to you on the request and utilize the cover sheets provided for each medical record. Please note: hospitals may have received recommendations to highlight or flag the copies of the requested records to indicate where key elements can be found in the chart. The CDAC has asked us to notify hospitals NOT to mark or flag the charts in any way as this interferes with their ability to complete an objective review of the record.

Additional Recources

Please visit our Web site at www.ipro.org where you will find additional information about validation studies by going to the sections: Professionals/ Hospitals/ Public Reporting Initiatives / Validation Studies (http://providers.ipro.org/index/hprp-validation-studies). You will also find information on the CMS QualityNet Exchange Web site at www.qnetexchange.org under both the "CART" and "HDC" tabs in the section labeled "Data Validation". We strongly encourage you to subscribe to the IPRO Hospital Public Reporting Email List Serve at http://www.ipro.us/mailman/listinfo/hprp. Once subscribed, you will receive information and updates about validation studies as well as other notices related to public reporting. Karen O'Leary is IPRO's primary liaison for validation studies. Karen may be contacted for questions, information and appeals at 1-800-233-0360 ext.124, or koleary@nyqio.sdps.org.

Conference Call Scheduled for Tuesday, June 8, 2004, 10:00 AM

IPRO is hosting a conference call to provide hospitals with information about the validation studies process and an opportunity to ask questions. We would like to extend an invitation to you and members of your Quality Department and other interested staff to join in. Call-in number and conference materials can be found on our Web site at http://providers.ipro.org/index/ccm-20040429.