Appendix 7_ROI_template DRAFT 10.4.2023.xlsx
XLSX spreadsheet 28 KB Posted
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- 13th SOW - QIN-QIO DRAFT SOW Federal contract opportunity
- Solicitation number
- Not on record
About this file
This document contains a template for reporting return on investment by aim and sub-aim for a Quality Improvement Network-Quality Improvement Organization (QIN-QIO) contract. The template includes sections for acute care hospitals, nursing homes, and outpatient clinician practices. It requires contractors to enter the proportion of effort expended on each sub-aim as a percentage of the total amount invoiced for that setting on a quarterly basis. The totals must sum to 100%. The related federal contract opportunity notice provides no additional salient details, simply listing the solicitation number, name, opportunity type and agency as the Centers for Medicare and Medicaid Services for a 13th Statement of Work for QIN-QIOs.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| QIN-QIO DRAFT SOD 10.4.23.docx | DOCX document | |
| Appendix 4_Detailed List of Measures with Specifications DRAFT.docx | DOCX document | |
| Appendix 6_Success Story Template DRAFT 10.4.2023.docx | DOCX document | |
| Appendix 9_CMS Security Privacy Requirements DRAFT 10.4.2023.docx | DOCX document | |
| Appendix 5_Assessment tool- Use of Data for QI DRAFT 10.4.2023.docx | DOCX document | |
| Appendix 2_IDFs DRAFT 10.4.2023.pptx | PPTX presentation | |
| Appendix 8_Additional Standards Guidelines and Best Practices for Data Submission Management Analytics and Reporting DRAFT 10.4.2023.docx | DOCX document | |
| Appendix 1_A3C Example and Template DRAFT 10.4.2023.docx | DOCX document | |
| Question Submission Format.xlsx | XLSX spreadsheet | |
| QIN-QIO Draft SOW - 13th Scope.docx | DOCX document | |
| Appendix 3_AHQT Technical Readiness Assessment Survey DRAFT.docx | DOCX document | |
| Appendix 10_13thSOW Terminology DRAFT 10.4.2023.docx | DOCX document |
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Text version
Acute Care Hospitals
| 13th SOW ROI Template | |||
| Aim | (Insert QIN-QIO Name) | Proportion of Costs by Aim and Sub-Aim for | |
| Months 1-3 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 7-9 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 10-12 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 13-15 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 16-18 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 19-21 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 22-24 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 25-27 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 28-30 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 31-33 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 34-36 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 37-39 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 40-42 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 43-45 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 46-48 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 49-51 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 51-53 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 54-57 | Proportion of Costs by Aim and Sub-Aim for |
Months 57-60
| Sub-Aim | ||||||||||||||||||||
| Advancing Healthcare Quality Through Technology | Advancing access and use of Health IT and interoperability for improving quality and outcomes | |||||||||||||||||||
| Behavioral Health | Depression and Suicide | |||||||||||||||||||
| Behavioral Health | Substance Use Disorders - Opioids, Alcohol and Polysubstance Abuse | |||||||||||||||||||
| Care Coordination | Hospital 30-Day Readmissions | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Resulting from emergency preparedness requirements | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Related to the 4 Aims | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Resulting from QAPI requirements | |||||||||||||||||||
| Patient Safety | Prevent Adverse Drug Events (ADE) | |||||||||||||||||||
| Patient Safety | Prevent Hospital-Associated Infections (HAI) | |||||||||||||||||||
| Patient Safety | Prevent Other Adverse Effects | |||||||||||||||||||
| Prevention | Increase Vaccination | |||||||||||||||||||
| Totals | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | |
| Total Invoiced to Support Acute Care Hospitals in Quarter (including Fee) |
Nursing Homes
| 13th SOW ROI Template | |||
| Aim | (Insert QIN-QIO Name) | Proportion of Costs by Aim and Sub-Aim for | |
| Months 1-3 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 7-9 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 10-12 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 13-15 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 16-18 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 19-21 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 22-24 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 25-27 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 28-30 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 31-33 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 34-36 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 37-39 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 40-42 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 43-45 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 46-48 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 49-51 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 51-53 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 54-57 | Proportion of Costs by Aim and Sub-Aim for |
Months 57-60
| Sub-Aim | ||||||||||||||||||||
| Advancing Healthcare Quality Through Technology | Advancing access and use of Health IT and interoperability for improving quality and outcomes | |||||||||||||||||||
| Behavioral Health | Depression and Suicide | |||||||||||||||||||
| Care Coordination | ED Utilization | |||||||||||||||||||
| Care Coordination | Readmissions to Hospitals from SNF | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Resulting from emergency preparedness requirements | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Related to the 4 Aims | |||||||||||||||||||
| Emergency Preparedness & Quality Management Infrastructure | Inspection Deficiencies Resulting from QAPI requirements | |||||||||||||||||||
| Patient Safety | Prevent Adverse Drug Events (ADE) | |||||||||||||||||||
| Patient Safety | Prevent Hospital-Associated Infections (HAI) | |||||||||||||||||||
| Patient Safety | Prevent Other Adverse Effects | |||||||||||||||||||
| Prevention | Increase Vaccination | |||||||||||||||||||
| Totals | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | |
| Total Invoiced to Support Nursing Homes in Quarter (including Fee) |
Outpatient Clinician Practices
| Appendix 7 | |||
| 13th SOW ROI Template | |||
| Aim | (Insert QIN-QIO Name) | Proportion of Costs by Aim and Sub-Aim for | |
| Months 1-3 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 7-9 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 10-12 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 13-15 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 16-18 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 19-21 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 22-24 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 25-27 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 28-30 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 31-33 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 34-36 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 37-39 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 40-42 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 43-45 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 46-48 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 49-51 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 51-53 | Proportion of Costs by Aim and Sub-Aim for | ||
| Months 54-57 | Proportion of Costs by Aim and Sub-Aim for |
Months 57-60
| Sub-Aim | ||||||||||||||||||||
| Advancing Healthcare Quality Through Technology | Advancing access and use of Health IT and interoperability for improving quality and outcomes | |||||||||||||||||||
| Behavioral Health | Chronic Pain | |||||||||||||||||||
| Behavioral Health | Depression and Suicide | |||||||||||||||||||
| Behavioral Health | Substance Use Disorders - Opioids, Alcohol and Polysubstance Abuse | |||||||||||||||||||
| Care Coordination | ED Utilization | |||||||||||||||||||
| Care Coordination | Hospital 30-Day Readmissions | |||||||||||||||||||
| Patient Safety | Prevent Adverse Drug Events (ADE) | |||||||||||||||||||
| Patient Safety | Prevent Other Adverse Effects | |||||||||||||||||||
| Prevention | Increase Vaccination | |||||||||||||||||||
| Prevention | Prevent or manage diabetes, hypertension, chronic kidney disease | |||||||||||||||||||
| Totals | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | 0% | |
| Total Invoiced to Support Outpatient Clinician Practices in Quarter (including Fee) |
Instructions
| 1. In each of the three tabs, enter the proportion of effort expended on each sub-aim as a percentage of effort invoiced in each setting |
| 2. The "Totals" row must add to 100%, and will appear in red highlighted if the total percentage is less than 99.9% or greater than 100.1% |
| 3. In the "Total Invoiced" row enter the total amount invoiced for that setting in the relevant contract quarter. Make sure to include the fee and any other charges associated with contract for the quarter. |
File details come from the government source that posted it. Updated .