Text Size

Provider Payment and Reporting

Temporary Pause of BFCC-QIO Short Stay and HWDRG Reviews

The Centers for Medicare & Medicaid Services (CMS) has temporarily paused the performance of both Short Stay reviews and Higher Weighted Diagnosis-Related Group (HWDRG) reviews by the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs). Short Stay reviews and HWDRG reviews will stop for a brief time beginning on May 8, 2019.

CMS took this action to procure a new BFCC-QIO contractor. Two BFCC-QIOs have done HWDRG reviews since 2014 and Short Stay reviews since 2015 for all 50 states and 3 territories. Going forward, Short Stay reviews and HWDRG reviews will resume with a single organization performing reviews on a national basis. CMS anticipates a contract award to be issued by the 3rd quarter of calendar year 2019.

If you have any questions or concerns please contact your BFCC-QIO contractor.

Livanta supports Idaho and Washington State: 877-588-1123.

Hospitals

With the implementation of the Affordable Care Act, and as part of the national effort to control costs and ensure quality for patients, Medicare is aligning reimbursement with performance. These programs include:

Hospital Value-Based Purchasing (VBP) Program

Medicare's hospital value-based purchasing (VBP) program ties payment to hospitals' performance on a number of quality measures. Because calculations change year to year, it is important that hospitals stay current on what measures are included and how their performance on those measures during defined performance periods will roll up into an overall total performance score (TPS). Visit our Hospital Value-Based Purchasing Program web page to learn more about the program.

Inpatient Quality Reporting (IQR) Program, including the:

Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS)

Healthcare-Associated Infections (HAI) data submission to the National Healthcare Safety Network (NHSN)

Outpatient Quality Reporting (OQR) Program

Download the April 2017 Hospital Performance Report for Emergency Department Measures for Washington State.  

Our Roadmap to Effective Quality Data Reporting outlines our recommended approach to successfully meeting the requirements of those programs. Please note that CMS manages several other hospital reporting programs. Please see below for related links.

 

Ambulatory Surgical Centers

Qualis Health has been working with Ambulatory Surgical Centers (ACSs) in Idaho and Washington to assist them in understanding and using the Centers for Medicare & Medicaid Services (CMS) quality measures. With the possibility of CMS raising expectations that “pay for reporting” will evolve into “public reporting” and then “pay for performance,” Qualis Health has been helping in navigating these changes. The Qualis Health ASC Learning and Action Network provided ASCs across Washington and Idaho an opportunity to receive technical assistance and peer-to-peer sharing. The webinars from the ASC Learning and Action Network are available below.

March 10, 2017

EQuIP for ASCs Overview - Download the recorded webinar. (To contact Jeff West, please use this email address: jeffwe@qualishealth.org, not the email address for Jeff in the presentation.)

April 21, 2017

Disease Transmission and Prevention Basics
Download the recorded webinar

May 12, 2017

Infection Prevention Survey Readiness - WA
Download the recorded webinar

May 19, 2017

Infection Prevention Survey Readiness - ID
Download the recorded webinar

July 21, 2017

Hand Hygiene
Download the recorded webinar

August 18, 2017

Team STEPPS for ASCs
Download the recorded webinar

September 22, 2017

Infection Surveillance for ASCs
Download the recorded webinar

October 20, 2017

Cleaning, Disinfection and Sterilization Part 1
Download the recorded webinar

November 17, 2017

Cleaning, Disinfection and Sterilization Part 2
Download the recorded webinar

January 19, 2018

Outbreak Investigations
Download the recorded webinar

February 16, 2018

Surveillance
Download the recorded webinar

March 16, 2018

Employee and Occupational Health
Download the recorded webinar

 

ASCs in Idaho please contact:

Martha Jaworski, BSN CIC MS
Quality Improvement Consultant
Send an email
208-383-5944

 

ASCs in Washington please contact:

Jeff West, MPH RN
Quality Improvement Consultant
Send an email

jeffwe@qualishealth.org
206-288-2465

Find Support for Other Programs

Please click the program name for related information.

Program for Evaluating Payment Patterns Electronic Report (PEPPER)

Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program

Inpatient Rehabilitation Facilities (IRF) Program

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Medicare Beneficiary Quality Improvement Project (MBQIP)