Hospitals-Inpatient — Overview
Through its hospital quality improvement initiatives, the Centers for Medicare & Medicaid Services (CMS) strives to improve the care provided by the nation’s hospitals and provide quality information to consumers and others.
Data collection and reporting are key to these initiatives—including the Hospital Quality Alliance (HQA): Improving Care through Information and Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU).
CMS requires participating hospitals—as well as their Performance Measurement Systems/vendors and Quality Improvement Organizations (QIOs)—to collect specified private healthcare data from medical records and electronically submit that data via the QualityNet website.* Hospitals may submit data for any of the four CMS national clinical topics: acute myocardial infarction, heart failure, pneumonia and surgical infection prevention.
Data is submitted via QualityNet to the QIO Clinical Warehouse, the national data repository for private healthcare data. All data and files are encrypted during transmission and stored in an encrypted format until they are downloaded by a recipient.
For successful transmission to the QIO Clinical Warehouse, data must be submitted by a registered QualityNet user (for more information, see QualityNet Registration) in specific XML format. CART, the CMS Clinical Abstraction and Reporting Tool, may be downloaded free of charge and used to assist providers in collecting and submitting data.
Once data is received and "accepted" by the QIO Clinical Warehouse, it is immediately analyzed and a variety of feedback reports are made available on the secure portio of QualtyNet (My QualityNet). The feedback reports are accessible only to an individual provider and its QIO, to assist in evaluating their current quality improvement efforts. The reports also allow hospitals to compare their quality improvement data to that of other facilities in their state and across the country.
To assure the accuracy of provider data that is to be publicly reported by CMS, a quarterly chart audit validation process is conducted on a random sample of cases submitted by a hospital during the previous quarter.
* QualityNet meets and exceeds all current Health Insurance Portability and Accountability Act (HIPAA) requirements.