NOTICES
DEPARTMENT OF
PUBLIC WELFARE
Hospital Quality Care Investment Grant Program and Hospital Quality Incentive Pilot Program
[36 Pa.B. 2235] The purpose of this notice is to provide public notice that the Department of Public Welfare (Department) is establishing a Hospital Quality Care Investment Grant Program and Hospital Quality Incentive Pilot Program for all acute care general hospitals that receive inpatient disproportionate share hospital (DSH) payments. Hospitals that receive inpatient DSH payments are eligible to apply for the Hospital Quality Care Investment Grant Program.
The Department published notice of its intent to establish a Hospital Quality Care Incentive Program at 35 Pa.B. 303 (January 8, 2005). Since that time the Department has collaboratively worked with the hospital industry in this Commonwealth to develop the Hospital Quality Care Investment Grant Program and Hospital Quality Incentive Pilot Program.
Hospital Quality Care Investment Grant Program
The purpose of the Hospital Quality Care Investment Grant Program is to establish an incentive for acute care general hospitals to initiate quality improvement projects by offsetting some of the costs related to implementing the quality improvement initiatives.
Period of the Grants
The grant period will be the State Fiscal Year (SFY) in which the grant is awarded. Grants will be awarded every SFY, beginning in the SFY 2005-2006.
Grant Limit
The grant funds will be distributed equally up to a maximum of $100,000 among qualifying hospitals, except that under no conditions shall a grant be awarded for a greater amount than the total cost of the quality related project. Grants are limited to one per hospital per grant period.
Spending Cycle
All moneys awarded to a hospital under this grant program must be spent within a 12-month period beginning on the day that the hospital receives its grant payment. If a hospital is unable to spend all moneys within the 12-month period, the Department may issue an extension.
Project Eligibility
The Department will consider projects or investments that have a direct impact on the quality of medical services and positive patient outcomes for this grant program. The Department will only consider new investments or projects that have been started within the last 12 months of the SFY.
Grant Application Reviews
The Department will use a Peer Review Committee (PRC) to review the applications submitted by acute care general hospitals under the Hospital Quality Care Investment Grant Program and announce the grant awards.
A PRC will be organized to review the grant applications. The PRC will consist of the following:
(1) The Deputy Secretary from the Office of Medical Assistance Programs, who shall serve as the PRC Chairperson.
(2) Three representatives from the hospital community with backgrounds in hospital quality improvement, who do not have any grant applications under consideration, and at least two of whom are physicians.
(3) One representative from the Pennsylvania Health Care Cost Containment Council (PHC4).
(4) One representative from the Department of Health.
(5) The Medical Director from the Office of Medical Assistance Programs.
The PRC will evaluate applications and measure the submissions against the Hospital Quality Incentive Pilot Program criteria. The PRC will consider reasonable, adequate and significant investments to fund quality improvement projects that meet any of the project criteria as having a direct impact on the quality of medical services and positive patient outcomes. The project criteria are as follows:
(1) The project involves one of the designated technology projects of the Hospital Quality Care Incentive Program (Single Medical Record or Pharmacy Error Reduction projects).
(2) The project involves piloting of emergency department claims.
(3) The project demonstrates a positive impact on the treatment of asthma, diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or the acute care general hospital's ability to satisfactorily comply with the Hospital Quality Incentive Pilot Program's measures related to left ventricular function (LVF) assessment and community acquired pneumonia.
(4) The project will have a direct impact on the quality of medical services and positive patient outcomes through a means not otherwise described in the project criteria.
Hospital Quality Incentive Pilot Program
The purpose of the Hospital Quality Incentive Pilot Program is to establish an incentive and to reward acute care general hospitals that demonstrate commitment to improved management of the healthcare needs of Medical Assistance (MA) recipients through the following:
(1) Better management of chronic disease.
(2) Better management of drug therapies.
(3) Better coordination with physicians, MA managed care organizations and the Access Plus Program.
(4) Investment in quality related infrastructure.
The Department will incrementally increase the adjustment factor applied to inpatient DSH and Medical Education payments for those acute care general hospitals that qualify under the Hospital Quality Incentive Pilot Program criteria, scoring matrix and scoring methodology established in this notice.
The Department will use the following criteria in determining the adjustments for those quality incentives.
Hospital Quality Incentive Pilot Program Criteria
Measures for acute care general non-children's hospitals:
(1) 7-Day Readmission Rates based on the most recent available PHC4 reports for the following:
* Asthma.
* Diabetes.
* CHF.
* COPD.
(2) LVF Assessment Score as reported by the Department of Health and Human Services Hospital Compare.
(3) Pneumonia Mean Time to First Antibiotic Score as reported by Department of Health and Human Services Hospital Compare.
(4) Implementation or Substantive Progress Towards the Use of a Formal Pharmacy Error Reduction Program by using technology, improving processes, zeroing in on errors that cause harm and building a culture of safety will be awarded one point. The hospital must demonstrate material commitment. Examples include the following:
* Pharmacy Legibility Improvement Program.
* Participation in ECRI (formerly the Emergency Care Research Institute), Institute for Safe Medication Practices (ISMP) and Delaware Valley Healthcare Council Regional Medication Safety Program.
* Completion of the ISMP's Medication Safety Assessment for 2004.
* Participation in the Pittsburgh Regional Healthcare Initiative Medication Safety Program.
* Use of medication error reporting tool such as MEDMARX, a National, internet-accessible database that hospitals and health care systems use to track and trend adverse drug reactions and medication errors.
* Established confidential medication error reporting system.
* Implemented point of care bar coding medication administration system or Computerized Physician Order Entry (CPOE).
* Automated Pharmacy System.
* Pharmacist availability 24 hours per day, 7 days a week.
(5) Reporting to One of the Following Quality Measurement Programs: Leapfrog, Centers for Medicare and Medicaid Services (CMS) Premiere or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Quality Check
Measures for acute care general children's hospitals:
(1) 7-Day Readmission Rates based on the most recent available PHC4 reports for asthma.
(2) Implementation or Substantive Progress Towards the Use of a Single Electronic Medical Record as described previously for acute care general non-children's hospitals.
(3) Implementation or Substantive Progress Towards the Use of a Formal Pharmacy Error Reduction Program as described previously for acute care general non-children's hospitals.
(4) 24-Hour Intensivist Coverage.
(5) Reporting to One of the Following: Leapfrog or field testing of JCAHO Pediatric Quality Measures.
Substantive progress may be evidenced by one of the following:
(1) Documentation of completion of the project--include summary of project components.
(2) Documentation of completion of part of the project--include summary of project components completed and components remaining.
(3) A signed contract with a vendor to launch the project--include summary of project components.
(4) An official record of a decision by the hospital board of directors to commit funds to the project. The submitted official record of decision must include a summary of project components and documentation of the steps taken to secure a vendor.
Adjustment Increases to Inpatient DSH and Medical Education Payments Based on Scoring
The Department will use a scoring methodology for acute care general non-children's hospitals based on points in order to determine the adjustment factor increase to inpatient DSH and Medical Education payments for payments occurring after January 1, 2006, as follows:
* 12-15 points--150% of scheduled adjustment factor increase
* 8-11 points--125% of scheduled adjustment factor increase
* 5-7 points--100% of scheduled adjustment factor increase
* 1-4 points--75% of scheduled adjustment factor increase
* 0 points--no adjustment factor increase
The Department will use a scoring methodology for acute care general children's hospitals based on points to determine the adjustment factor increase to inpatient DSH and Medical Education payments for payments occurring after January 1, 2006, as follows:
* 5-6 points--150% of scheduled adjustment factor increase
* 3-4 points--125% of scheduled adjustment factor increase
* 2 points--100% of scheduled adjustment factor increase
* 1 points--75% of scheduled adjustment factor increase
* 0 points--no adjustment factor increase
Scoring
Scoring Matrix for acute care general non-children's hospitals*
* 2 points for fewer than expected readmissions for asthma, diabetes, CHF and COPD
* 1 point for expected readmissions for asthma, diabetes, CHF and COPD
* 0 points for more than expected readmissions for asthma, diabetes, CHF and COPD
* 2 points for hospitals who score in the top decile for the LVF Assessment Score or Pneumonia Mean Time to First Antibiotic Score
* 1 point for hospitals that score in the second, third and fourth deciles for the LVF Assessment Score or Pneumonia Mean Time to First Antibiotic Score
* 0 points for hospitals that score in the bottom decile for the LVF Assessment Score or Pneumonia Mean Time to First Antibiotic Score
* 1 point each for single medical record, pharmacy error reduction, and Leapfrog, CMS Premiere or JCAHO Quality Check
Scoring matrix for acute care general children's hospitals*
* 2 points for fewer than expected readmissions for asthma
* 1 point for expected readmissions for asthma
* 0 points for more than expected readmissions for asthma
* 1 point each for a single medical record and formal pharmacy error reduction program as described previously
* 1 point for 24-hour Intensivist Coverage
* 1 point for reporting to Leapfrog or field testing of JCAHO Pediatric Quality Measures
* Hospitals participating in the Hospital Quality Incentive Pilot Program that have an insufficient number of cases to calculate a 7-day readmission rate will be assigned one point for each of the four chronic conditions where a readmission rate is unavailable.
Fiscal Impact
The fiscal impact of these changes is estimated at $1.512 million ($0.680 million in State funds) in Fiscal Year (FY) 2005-2006 and $1.920 million ($0.870 million in State funds) in FY 2006-2007.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision of the notice.
Persons with a disability who require an auxiliary aid or service may submit comments using the AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
ESTELLE B. RICHMAN,
SecretaryFiscal Note: 14-NOT-471. (1) General Fund; (2) Implementing Year 2005-06 is $680,000; (3) 1st Succeeding Year 2006-07 is $870,000; 2nd Succeeding Year 2007-08 is $704,000; 3rd Succeeding Year 2008-09 is $704,000; 4th Succeeding Year 2009-10 is $704,000; 5th Succeeding Year 2010-11 is $704,000; (4) 2004-05 Program--$531,785,000; 2003-04 Program--$411,042,000; 2002-03 Program--$407,104,000; (7) Medical Assistance--Inpatient; (8) recommends adoption. Funds are available in the 2005-2006 budget for this purpose. Funds have also been included in the Governor's requested 2006-07 budget.
[Pa.B. Doc. No. 06-785. Filed for public inspection May 5, 2006, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.This material has been drawn directly from the official Pennsylvania Bulletin full text database. Due to the limitations of HTML or differences in display capabilities of different browsers, this version may differ slightly from the official printed version.
