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Attachment J.1a Glossary of Terms and Acronyms
GLOSSARY OF TERMS AND ACRONYMS
Glossary of Terms
| Aim |
| An AIM is a term used in strategic planning that identifies the overall goal or outcome to be achieved. Quality Improvement requires setting aims. Aims are time-specific and measureable; it defines the specific populations of beneficiaries and providers that will be affected. |
| Base Contract |
| The overarching Indefinite Delivery/Indefinite Quantity (IDIQ) contract to procure ESRD Network and QIN-QIO expert healthcare quality improvement services which includes a broad base of strategic initiatives and requirements the ESRD Network and QIOs may be tasked to implement through the execution of individual Task Orders. |
| Beneficiary- and Family-Centered Care (BFCC) QIO |
| A contractor awarded a BFCC-QIO contract by CMS; the purpose of the BFCC-QIO contract is to improve healthcare services through numerous statutory review functions, including, but not limited to, quality of care reviews, beneficiary complaint reviews, discharge and termination of service appeals in various provider settings, medical necessity reviews, and Emergency Medical Treatment and Labor Act (EMTALA) reviews. |
| BFCC National Coordinating & Oversight Review Center (NCORC) |
| Provide independent direct support services to CMS and the BFCC Program. Communication between CMS and QIOs, assures QIOs have information/resources needed, and provide technical assistance, monitor and evaluates BFCC-QIO activities and technical support. |
| Beneficiary and Family-Centered Care (BFCC) Oversight & Review Center (ORC) |
| The contractor awarded the BFCC ORC contract by CMS; the purpose of the BFCC ORC is to focus on consistency across areas, recommend initiatives to improve case review quality (e.g., inter-rater reliability), and administer satisfaction surveys to providers and beneficiaries. |
| BFCC Survey Center (BFCC SC) |
| Maintains, administers, and evaluates experience survey and focus groups targeting providers and beneficiaries. |
| CMS Strategic Goals |
| The Centers for Medicare and Medicaid Services Strategic Goals are: |
1. Empower patients and doctors to make decisions about their health care
2. Usher in a new era of state flexibility and local leadership.
3. Support innovative approaches to improve quality, accessibility, and affordability.
4. Improve the CMS customer experience.
| Community Coalition |
| A community coalition is a group of stakeholders (providers, social services, state and local government, payers, etc) collaborating to achieve shared goals in providing healthcare and community based services to support individuals residing in a specified geographic area (community). |
| Community Engagement |
| The CDC’s Principles of Community Engagement defines community engagement as “the process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being.” |
Examples are regularly contributing at community meetings and establishing cross-setting communication, data-sharing, and information-sharing.
| Cross-sectional Performance Measures |
| CMS defines performance measures as “a gauge used to assess the performance of a process or function of any organization. |
Quantitative or qualitative measures of the care and services delivered to enrollees (process) or the end result of that care and services (outcomes). Performance measures can be used to assess other aspects of an individual or organization's performance such as access and availability of care, utilization of care, health plan stability, beneficiary characteristics, and other structural and operational aspect of health care services.” Cross-sectional refers to data collected from a population by observing a representative subset of the population without regard for time.
| ESRD |
| End-stage renal disease (ESRD) is the last stage (stage 5) of chronic kidney disease. When the kidneys fail completely, it means they have stopped working well enough for a person to survive without dialysis or a kidney transplant. |
| ESRD Network |
| An ESRD Network is an entity having responsibility of ensuring quality of care and access to care in all Medicare-approved ESRD facilities and for ESRD patients within a designated geographic area specified by CMS. |
| Goal |
| A measurable and time-bound desired purpose that directs efforts towards a common outcome. |
| HCQIS |
| The Centers for Medicare and Medicaid Services (CMS) Center for Clinical Standards and Quality (CCSQ) manages the Healthcare Quality Information System (HCQIS). HCQIS is the CCSQ managed IT program compiled an Infrastructure of IT systems, networks and computers within a General Support System (GSS). The GSS is also known as QualityNet (Q-Net) system, an environment that makes use of shared database servers and Wide Area Network (WAN) resources to deliver program value to patients and families, maximize learning and collaboration for improving care, and support the spread and sustainment of effective new practices and models of care for Medicare and Medicaid beneficiaries. QualityNet resources comprise but are not limited to the following: |
· The Ventech HCQIS (Health Care Quality Improvement System) Raging Wire Data Center in Ashburn VA;
· One Clinical Data Abstraction Center (CDAC) located in York, PA;
· Ventech contractor support locations CMS organizational business processes supported by QualityNet include:
· Capability for collection and management of clinical, survey, and project data from Medicare and Medicaid providers.
· Management and analysis of the clinical, survey, and project data by the QIOs
· Collection of data by ESRD Network Organizations to administer the national Medicare ESRD program
· Management and provision of Medicare and Medicaid information to providers that include, but are not limited to Hospitals, physicians or family practice clinics, dialysis clinics, Skilled Nursing Facilities, Home Health Agencies, and various specialized clinics
| HHS Action Plan to Reduce Racial and Ethnic Health Disparities |
| Outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. With the HHS Disparities Action Plan, the Department commits to continuously assessing the impact of all policies and programs on racial and ethnic health disparities. It will promote integrated approaches, evidence-based programs and successful interventions to reduce these disparities. The HHS Action Plan builds on the strong foundation of the Affordable Care Act. (http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285) |
| Hospital Improvement & innovation Network (HIIN) |
| The Hospital Improvement Innovation Networks (HIINs), formerly known as Hospital Engagement Networks (HENs), engage the hospital, provider, and broader care-giver communities to quickly implement well-tested and measured best practices. The end result of the overall initiative is the anticipated reduction in hospital-based harm and readmissions for patients. |
| Independent Evaluation Center (IEC) |
| A contractor will be responsible for providing information for ongoing program improvement, evaluate the effectiveness of this program in improving the quality of healthcare of 50 million American elderly beneficiaries, and advise CMS. |
| Indefinite Delivery, Indefinite Quantity (IDIQ) Contracts |
| A contract for services that does not procure or specify a firm quantity of services (other than a minimum or maximum quantity) and that provides for the issuance of orders for the performance of tasks during the period of the contract.” The government places task orders (for services) against a Base Contract for individual requirements. |
| Innovation |
| To make changes or to do something in a new way; a new idea, method, or device; a novelty. |
| Kaizen |
| According to the Project Management Institute, “the Japanese term kaizen, which means continuous improvement, is popular in process improvement circles such as Six Sigma and Lean. Kaizen is used to eliminate waste and make small, incremental improvements that accumulate into significant results.” |
| Key Personnel |
| Essential personnel designated by CMS within the IDIQ/ Task Order |
Learning and Action Networks
(LAN)
A cadre of healthcare practitioners, providers, and citizens who come together for the purpose of implementing change and spreading evidence-based practice through peer-to-peer learning and solution-sharing to improve care delivery and outcomes. Networks find new ways to improve processes by changing behavior on a large scale; for example, by providing a structured opportunity for the exchange of information at all levels. Networks are skilled at iterative testing, using sound measurement, providing system analysis, and managing a group to move toward a goal. The LAN model includes collaborative projects, online interactions, and peer-to-peer education to facilitate shared commitment, energy, and knowledge that allows participants to learn from each other. Members typically are participant providers, mentor providers, field offices or affinity groups, and national partners.
| Learning Session |
| Learning sessions can be virtual or face-to-face and occur at regular intervals to move a collective goal(s) forward. ESRD Network and QIO events/learning sessions are centered around an action-based agenda that is focused on the practices of high performers in an all-teach, all-learn fashion. |
| Lean Processes |
| The Institute for Healthcare Improvement states that the “focus of Lean is improving value from the customer’s point of view, by reducing waste of time and resources.” The basic steps for Lean include understanding "Value" from the customer's point of view; developing a "Value Stream (VS)" to determine steps, value added, and identify waste; and improving flow, cycle time, and value. |
| Local Presence |
| Local presence includes the ability to interact with and have quick access to a participating community and the providers in that community. The contractor should have knowledge of the culture, practices, and improvement needs of a community in which it is working and apply that knowledge to its case review and quality improvement projects. Local presence does not necessarily require a brick-and-mortar presence. The contractor should be located in the geographic location(s) in which it can best meet the needs of its populations and communities and establish the necessary strong relationships within the states and at the facility and practice level necessary to accomplish the goals of the contract. The term also does not mean that the contractor must allocate its resources equally within each state of its area but CMS does expect local activity and resources dedicated to each state served. The ability of contractor to meet the needs of its entire area is paramount. CMS will monitor to ensure that each state in the area is improving in the established goals based on the terms of the contract. |
| Medicare Administrative Contractor (MAC) |
| CMS contractors that process and pay Medicare Parts A and B fee-for-service claims. The MACs serve as the providers’ primary point-of-contact for enrollment, training on Medicare coverage and billing requirements, and the receipt, processing, and payment of Medicare fee-for-service claims within their respective jurisdictions. |
| Medicare Fee-for-Service Compliance Program |
| The Medicare Fee-for-Service Compliance program prevents, reduce and measure improper payments in FFS Medicare through medical review. This program provides information for ongoing program improvement, evaluate the effectiveness of this program in improving the quality of healthcare of 50 million American elderly beneficiaries, and advise CMS. |
| Network of Quality Improvement and Innovation Contractor (NQIIC) |
| Contractor to support quality improvement efforts across settings and programs to maximum impact to healthcare and value to taxpayers. The IDIQ contract allows for the full spectrum of quality improvement work that is in operation under the current various networks. This work currently includes the QIN-QIO work, the ESRD Network work, the hospital focused large scale improvement work, clinician-focused technical assistance work, and other quality improvement work. |
| Network of Quality Improvement & Innovation Contractor (NQIIC) Support Contractors |
| CMS contractors that will be used to identify & provide rapid data & information for ongoing program improvement, evaluate the effectiveness of the QI program in general to improve quality of healthcare of over 50 million elderly American beneficiaries, and advise CMS. Note, includes former National Coordinating Center (NCC), National Content Developer (NCD), Program Collaboration Center (PCC) contractors. |
| Partner |
| An organization or entity with which the contractor joins in commitment to the shared success of a mutually beneficial project or process. Partners are more engaged than stakeholders in that partners have actively agreed not only to transact with the contractor, but to take actions; make in-kind contributions of expertise, labor, and/or time; and share in the risk/benefit of failure/success that increases the value of the work beyond that which the contractor may have accomplished independently. |
| Patient Engagement |
| A set of behaviors performed by patients, family members and health professionals and a set of organizational policies and procedures that foster both the inclusion of patients and family as active members of the healthcare team and collaborative partnerships with providers and provider organizations (source AHRQ) Greater engagement of patients, families and the public has the potential to transform every dimension of healthcare. |
| PDSA Cycles |
| Plan-Do-Study-Act cycles: A structured trial of a process changes. Drawn from the Shewhart cycle, this effort includes: Plan - a specific planning phase; Do - a time to try the change and observe what happens; Study - an analysis of the results of the trial; and Act - devising next steps based on the analysis. |
| Practitioners (Participating Practitioners) |
| A practitioner is “an individual credentialed within a recognized health care discipline and involved in providing the services of that discipline to patients.” See also 45 C.F.R. § 476.1. As used in this SOW, “practitioner” includes a physician, as defined in § 1861(r) of the Social Security Act. |
“Participating Practitioners” refer to practitioners participating in the QIO quality improvement efforts.
Examples of practitioners include the following: Physicians, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist (and Anesthesiologist Assistant), Certified Nurse Midwife, Clinical Social Worker, Clinical Psychologist, Registered Dietician, Nutrition Professional, Audiologist.
| Program Collaboration Center (PCC) |
| A contractor awarded a PCC contract by CMS; the purpose of the Program Collaboration Center is to operate LANs, prepare quarterly reports, systematically collect success stories, disseminate data analysis and reports, identify high performing providers, provide training to QI staff, coordinate gaps, and facilitate communication and compliance. |
| Promising Practice |
| A promising practice is a technique or methodology that has yet to obtain the level of supporting evidence characteristic of a successful practice. It may show early promise in current testing effectiveness but needs more time and/or data to fully demonstrate continued superior performance. To become a successful practice, a promising practice should demonstrate the ability to spread. |
Provider
According to the Social Security Act Sec. 1861(u) (42 U.S.C. 1395), the term “provider of services” means a hospital, critical access hospital, skilled nursing facility, comprehensive outpatient rehabilitation facility, home health agency, or hospice program.
| Racial, Ethnic, and Rural Disparities |
| Racial and ethnic disparities are divided into four categories of individuals for purposes of collecting data on race: 1) American Indian or Alaska Native; 2) Asian; 3) Black or African-American; and 4) Native Hawaiian or Other Pacific Islander. There are 2 categories for data on ethnicity: Hispanic or Latino, and Non-Hispanic/Latino. “Rural” encompasses all population, housing, and territory not included within an urban area (50,000 people or more), as defined by the U.S. Census Bureau. |
| Relative Improvement Rate (RIR) |
| The absolute improvement divided by the difference between the baseline performance and perfect performance (100%). |
| Rural Population |
| Rural Populations consists of any individual that lives in rural areas or primary flow to a tract outside of an urban area or an urban commuting area. |
| Service Area |
| The local, state, or regional geographic jurisdiction as established by CMS awards. |
| Stakeholders |
| Stakeholders may include, but are not limited to: |
· Patients, especially Medicare beneficiaries,
· Community/Family advocates and change agents –relatives, community members involved with the patient, and those concerned with community health such as churches, community centers, group homes, social service agencies,
· Healthcare organizations, providers and practitioners– those involved with healthcare including hospitals, physicians, dentists, therapists, nursing homes, home health agencies, and the professionals, paraprofessionals, and others who staff them,
· Analysts – statisticians, demographers, epidemiologists, operations research, business analysts, financial analysts, geographers, mathematicians, social scientists, public health and others knowledgeable about such domains,
· Community leaders at all levels, not only those elected but also those recognized as leaders by virtue of their public advocacy role,
· Communications and media individuals
· Business leaders, especially those whose businesses are affected by the CMS targeted measures, and
· Technical experts, advisors, resource staff, managers, financial counselors, lawyers, and other such individuals and staff from others who given their established expertise
| Statement of Work (SOW) |
| Refers collectively to the breadth of QI efforts over the award period. The Statement of Work encompasses the Base Contract, task orders, background, requirements, schedule of deliverables, measures, and appendices associated with the contract. |
| Strategic Innovation Engine (SIE) |
| A system for extracting “best practices” from the field for review and possible spread and dissemination. Practices may be culled from systematic review, innovation projects, and high performers as examples. The goal of the engine is to create pull and acceptance of QI practices in healthcare; create an organizing structure that reviews practices (i.e. unintended consequences) and provides a mode of rapid dissemination based on the six goals of the CMS Quality Strategy. |
| Successful Intervention or Practice |
| A successful intervention or practice (sometimes called a best practice) is a technique or methodology that has proven performance results that are superior to standard practices over a period of time. Successful interventions or practices demonstrate improvement, are supported by data and appropriate methodologies, and also demonstrate many, but not necessarily all, of the following characteristics: |
· Innovation
· System or process-based
· Spreadable
· Reliable
· Sustainable Successful interventions or practices are evidence-based meaning that they have been tested, measured, and shown to be successful.
| Targeted Populations |
| People with a specific commonality that a quality improvement intervention is aimed towards. The targeted population may change with each intervention. The targeted population may or may not be ethnic and racial minorities. |
| Task |
| A broad description of a healthcare quality improvement focus area, collection of specific activities, and performance requirements. |
| Task Order |
| According to the Federal Acquisition Regulation, a “Task order” means an order for services placed against an established contract or with Government sources. |
| Technical Assistance |
| Technical assistance is the provision of expertise, coaching, information, advice, tools, training and consultancy to individuals or groups who are in need of help in an area in order to move to the next level of improvement. Technical assistance may take many forms depending on the nature of the needs. A needs assessment, root cause analysis, or review of data is often conducted to determine the nature of the needed assistance. |
| Vulnerable Populations |
| The Office of Minority Health (OMH) defines vulnerable populations to include 1) racial and ethnic minorities, 2) individuals with disabilities, 3) sexual and gender minorities, individuals living in rural areas, 4) and also consider those are dually-eligible among vulnerable population groups. We recognize there are other vulnerable populations, but these are the target populations we are focusing on for this statement of work. The size of these vulnerable populations will vary depending upon the contractor’s region. Each contractor will define the targeted vulnerable populations from a list of populations and the specific targets for this population itself. |
Glossary of Acronyms
| BFCC-NCC QIO |
| Beneficiary and Family-Centered Care National Coordinating Center QIO |
| BIPA |
| Benefits Improvement and Protection Act |
| CASPER |
| Certification and Survey Provider Enhanced Reporting |
| CCSQ |
| Center for Clinical Standards and Quality, a Center within CMS |
| CMS |
| Centers for Medicare & Medicaid Services |
| COR |
| Contracting Officer’s Representative |
| EHR |
| Electronic Health Record |
| EMTALA |
| Emergency Medical Treatment and Active Labor Act |
| ESRD |
| End Stage Renal Disease |
| HCQIS |
| Healthcare Quality Information System |
| HHS |
| Department of Health and Human Services |
| HIIN |
| Hospital Innovation Improvement Network |
| HINN |
| Hospital-Issued Notices of Non-Coverage |
| HWDRG |
| Higher-Weighted Diagnosis-Related Groups |
| IDIQ |
| Indefinite Delivery/Indefinite Quantity |
| IEC |
| Independent Evaluation Center |
| ISG |
| Information Systems Group |
| IT |
| Information Technology |
| LAN |
| Learning and Action Network |
| MAC |
| Medicare Administrative Contractor |
| MNT |
| Medical Nutrition Therapy |
| OCR |
| Office of Civil Rights |
| OGC |
| Office of the General Counsel |
| PCC |
| Program Collaboration Center |
| PP |
| Participating Practice |
| OIG |
| Office of Inspector General |
| QAPI |
| Quality Assurance and Performance Improvement |
| QCR |
| Quality of Care Review |
| QIG |
| Quality Improvement Group |
| QII |
| Quality Improvement Initiative |
| QIO |
| Quality Improvement Organization |
| QPP |
| Quality Payment Program |
| RAC |
| Recovery Audit Contractor |
| SDPS |
| Standard Data Processing System |
| SIE |
| Strategic Innovation Engine |
| SIP |
| Special Innovation Project |
| SSA |
| State Survey Agencies |
| SME |
| Subject Matter Expert |
| TOPS |
| Transmittal of Policy System |
