Data Validation Overview
Hospitals-Inpatient
Assuring data accuracy is vital to public reporting programs. The Centers for Medicare & Medicaid Services (CMS) assesses the accuracy of chart-abstracted data submitted to the Hospital Inpatient Quality Report (IQR) program through its validation process. CMS verifies, on a quarterly basis, that hospital-abstracted data submitted to the QIO Clinical Warehouse can be reproduced by a trained abstractor using a standardized protocol.
Provider Selection
CMS performs a random and targeted selection of Inpatient Prospective Payment Systems (IPPS) hospitals on an annual basis. As further described on QualityNet, all hospitals successfully submitting at least one Hospital IQR Program case for the third calendar quarter of the previous Calendar Year (CY) are eligible for the random selection of hospitals for validation. For example, for the Fiscal Year (FY) 2015 payment determination, CMS selected the sample early in calendar year 2013, considering all hospitals that submitted at least one case to IQR in the third quarter of CY 2012.
In addition to the randomly selected hospitals, CMS selects at a later date a targeted sample of additional hospitals. In the targeted sample, CMS includes all hospitals with a Confidence Interval (CI) calculation less than 75 percent for the previous payment determination year and a sample of hospitals meeting other targeting criteria as specific in the IPPS Final Rule. Once CI results are calculated for the previous payment year, CMS notifies all targeted hospitals of their selection and provides validation requirements along with submission deadlines.
Record Selection
Starting with FY 2015, CMS will validate up to 15 clinical process of care cases and 12 candidate Healthcare-Associated Infections (HAI) cases per quarter. The 15 clinical process of care cases will consist of up to three cases per measure set for the clinical process of care measure sets. Up to 12 cases will be validated for the HAI measures, Central Line Associated Blood Stream Infection (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), and Surgical Site Infection (SSI). CLABSI and CAUTI cases will be selected from the data provided on the Validation Blood and Urine Culture Templates submitted quarterly for positive cultures taken from intensive care unit patients. SSI cases will be selected from claims data.
For more information regarding medical records requested by the Clinical Data Abstraction Center (CDAC), see CDAC Contact Information.
Validation Rates
CMS will provide two separate scores for FY 2015 and forward, one for the clinical process of care measure sets and one for the HAI measure sets.
CMS will calculate a total score reflecting a weighted average of each of the two individual scores for the clinical process of care and HAI cases. After the scores are combined, CMS computes a confidence interval around the combined score. If the upper bound of this confidence interval is 75 percent or higher, then the hospital will pass the Hospital IQR Program validation requirement.
See Data Validation Resources for more information regarding the validation process.