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Attachment J.8- Glossary of Terms and Acronyms
HHSM-500-2014-RFP-QIN-QIO
GLOSSARY OF TERMS
| Accountable Care Organization (ACO) |
| A group of health care providers that agree to be accountable for the quality, cost, and overall care of the Medicare beneficiaries who are enrolled in the traditional fee-for-service program for whom the ACO is accountable. |
| Adverse Drug Event |
| An avoidable harm to a patient associated with medication use. |
| Allied Health Professional |
| Allied health professions are health care professions distinct from dentistry, optometry, nursing, medicine, and pharmacy. |
| Area |
| The QIO’s local, state, or regional geographic jurisdiction as established by CMS’s QIO awards. |
| Base Contract |
| The overarching Indefinite Delivery/Indefinite Quantity (IDIQ) contract to procure QIN-QIO expert healthcare quality improvement services which includes a broad base of strategic initiatives and requirements the 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. |
| Beneficiary- and Family-Centered Care (BFCC) National Coordinating Center (NCC) |
| The contractor awarded the BFCC NCC contract by CMS; the purpose of the BFCC NCC is to operate as a communication liaison between CMS and the BFCC-QIOs and to provide technical support ensuring that the BFCC-QIOs have the information and resources needed to support BFCC functions. This work will involve BFCC related analyses, recommendations to CMS and/or BFCC-QIO, use of designated case review systems, dissemination of instructions and guidance to the BFCC community, and collaboration initiatives. |
| 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. |
| Quality Innovation Network (QIN) NCC |
| The contractor awarded the QIN NCC contract by CMS; the purpose of the QIN NCC is to provide general and specific interventions as well as to collect and analyze national-level data, and provide technical assistance and support to QIN QIOs, CMS and other Federal partners. |
| Breakthrough Series Collaborative |
| According to the Institute for Healthcare Improvement, a Breakthrough Series Collaborative is a short-term (12 to 18-months) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area. For purposes of this contract, a collaborative shall be based on the Institute for Healthcare Improvement Collaborative Model. This model is designed to help organizations create a structure in which interested organizations can easily learn from each other and from recognized experts in topic areas where they want to make improvements. (http://www.ihi.org/knowledge/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx) |
Campaign
A campaign is an effort to achieve a particular result; campaigns form around a social need or issue by recruiting individuals to achieve a particular result. A campaign typically has a formal kick-off, peaks of action, and ends with the issue moving towards a resolution.
| Care Coordination |
| Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's/ beneficiary’s acute and/or long-term care to facilitate the appropriate delivery of services for the patient/beneficiary. Organizing care involves the marshaling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care.” (http://www.ahrq.gov/research/findings/evidence-based-reports/caregaptp.html) |
| Care Management |
| Care Management is a set of evidence-based, integrated clinical care activities that are tailored to the individual patient, and that ensure each patient has his or her own coordinated plan of care and services. For example, using of an electronic health record (EHR), such as maintaining a problem and diagnosis list; identifying specific beneficiaries by age and disease or disease risk; creating printed beneficiary specific care plans, to track and recall beneficiaries for needed preventive services and other care. |
| Certified Electronic Health Record Technology (CEHRT) |
| Electronic health record (EHR) technology that has been tested and certified in accordance with the certification program as established by the Office of the National Coordinator for Health Information Technology via rulemaking, 77 Fed. Reg. 54163 (Sept. 4, 2012). |
Change Package
A specific menu of strategies, change concepts, and actionable items grounded in successful interventions of high performers that another person/organization can select from to complete tests of change.
| Clinical Pharmacy Services |
| Services to promote the appropriate selection, utilization, and monitoring of medications to optimize individual therapeutic outcomes in patients receiving the services included in the Collaborative. Clinical pharmacy services are provided by a multidisciplinary health care team through individualized patient assessment and management. These services are best provided by a pharmacist or by another health care professional in collaboration with a pharmacist. |
CMS Quality Strategy
Developed by CMS in accordance with legislation in the Affordable Care Act (ACA) of 2010 which requires each agency within the Department of Health and Human Services to report on its progress and development of a Quality Strategy. CMS’s Quality Strategy is built on the foundation of the CMS Strategy, Enterprise Business and Operations Transformation Plan and the HHS National Quality Strategy, and is designed to guide the activities of the various components throughout the agency.
| Collaborative |
| A short-term (12 to 18 months) learning model that brings together a large number of teams from healthcare-affiliated stakeholders to seek improvement in focused topic areas or to achieve a measurable goal. For the purpose of this contract, a collaborative shall be based on the Institute for Healthcare Improvement Collaborative Model (www.ihi.org ). |
| Community |
| A group of vested people, as individuals or members of organizations, who have collectively identified and defined a purpose, established or adopted a goal, and developed or accepted a coordinated strategy for achieving said goal. Community participants may include but are not limited to individuals (including beneficiaries, family members and caregivers), medical and/or long term services and support providers, advocacy organizations, social service organizations, local/county government agencies, facilities, businesses, churches and other religious organizations, and/or professional societies. |
| Community Coalition |
| A group of providers, partners and/or stakeholders with an existing charter or agreement, or who have signed a community coalition charter or similar agreement within 3 months of QIN-QIO initiating recruitment of community participants. |
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.
| Community Organizing |
| According to the NIH/CDC’s Clinical and Translational Science Awards Community Engagement Committee, “the foundation for community organizing is the principle of social action, bringing people together — often, but not exclusively, from the same neighborhood — to pursue a shared interest.” (http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf; page 12) |
| Community Tenure |
| The length of time a beneficiary remains in their home setting between hospitalizations and short-term institutional stays. |
| Commercial off-the-shelf (COTS) |
| Software that is purchased and that does not require extensive programming and coding to be made useful to the end user. Examples include MS Windows, MS Office, MS Explorer, SAS, and Oracle. |
| Comprehensive Unit-based Safety Program (CUSP) |
| A safety culture program that is designed to: a) educate and improve awareness about patient safety and quality of care, b) empower staff to take charge and improve safety in their workplace, c) create partnerships between units and hospital executives to improve organizational culture and d) provide resources for unit improvement efforts, and provide tools to investigate and learn from defects. The program focuses on a unit’s workplace culture by providing a structured process aligned with the organization’s strategic plan and by engaging local frontline staff who prevent safety hazards daily. |
| 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.
DSME Programs/ Curricula DEEP – Diabetes Empowerment Education Program. This evidence –based diabetes education curriculum was developed at the University of Illinois at Chicago .
Stanford – Diabetes Self-Management Program (DSMP), and Chronic Disease Self-Management Program (CDSMP), which includes diabetes. These evidence-based diabetes and chronic disease education curricula were developed at Stanford University.
Project Dulce - Means “Project Sweet” in Spanish. This evidence-based diabetes education curriculum was developed at the Scripps Institute (now known as Scripps Health), in San Diego, CA.
| Dual-eligible |
| Persons who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid. |
| Electronic Health Record (EHR) Reporting |
| Direct electronic reporting from an EHR to a central database, such as a state immunization registry, that follows electronic reporting standards and regulations. |
| Everyone with Diabetes Counts (EDC) |
| The Everyone with Diabetes Counts program is designed to help Medicare beneficiaries with diabetes who are members of vulnerable populations actively participate in their care. Beneficiaries complete diabetes self-management education classes that focus on basic anatomy, healthy lifestyles, healthy nutrition choices, and the importance of eye exams, foot exams, and regular laboratory tests such as hemoglobin A1c and lipid panels. Classes are taught in community locations rather than traditional health care settings. |
| Goal |
| A measurable and time-bound desired purpose that directs efforts towards a common outcome. |
| Group Practice (as a Participating Practice in EDC, including managed care practices) |
| To be included as a Participating Practice in EDC, at least 40 % of the full-time physicians in the group practice (that is, one who practices more than 34 hours per week) must be primary care physicians (that is, physicians who have a primary specialty designation of General Practice, Family Practice, Internal Medicine or Geriatrics). A Certificate of Added Qualifications in Geriatric Medicine does not change the status of a physician whose primary specialty designation is other than General Practice, Family Practice, or Internal Medicine. |
| Healthcare-Acquired Conditions (HACs) |
| An undesirable situation or condition that arose during a stay in a hospital, medical, or nursing home facility and adversely affects a resident/beneficiary. |
| Healthcare-associated infection (HAI) |
| Infections that patients acquire during the course of receiving healthcare treatment for other conditions. HAIs are one type of HACs. An infection is considered an HAI if all elements of a CDC/NHSN site-specific infection criterion were first present together on or after the third (3rd) hospital day (day of hospital admission is day 1). For an HAI, an element of the infection criterion may be present during the first two (2) hospital days as long as it is also present on or after day three (3). All elements used to meet the infection criterion must occur within a timeframe that does not exceed a gap on one (1) calendar day between elements. The CDC classifies CLABSI, CAUTI, CDI, and SSI infections as HAIs. |
| Health Care Quality Information System (HCQIS) |
| HCQIS (Health Care Quality Information System) and QIES are national IT systems which contain a host of database applications, hardware, and networking that support Quality Improvement Organizations (QIOs), End Stage Renal Disease (ESRD) Networks (17 nationally dispersed organizations), State Survey Agencies (one agency for each State), Home Health Agencies, Nursing Homes, Hospital and Physician Quality Reporting Programs, Hospital and ESRD Value Based Purchasing Programs. The HCQIS also integrates with other CMS programs that collect quality data for payment purposes. |
| Health Information Technology Research Center (HITRC) |
| Section 3012 (b) of the Public Health Services Act, as added by section 13301 of the HITECH Act (PL 111-005); Section 3012 establishes the Health Information Technology Research Center (HITRC). The HITRC’s mission is to accelerate the adoption and meaningful use of EHRs. The HITRC convenes Regional Extension Centers and provides tools and expertise toward collaboration in accelerating adoption and meaningful use of health information technology used to improve the quality of patient care. (www.hitrc-learn.org/) |
| 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) |
| High-Performing Entities |
| High-performing entities are any provider, organization, facility, and/or community that consistently produce outstanding results with the highest level of satisfaction and commitment to success. |
| Home Health Quality Improvement National Campaign |
| Since 2007, the Home Health Quality Improvement (HHQI) National Campaign has been dedicated to improving the quality of care provided to home health beneficiaries across the country. Some of the beneficiary resources provided to home health agencies are focused on reducing unnecessary hospitalizations, improving flu and pneumonia immunization rates, improving oral medication management, preventing falls, improving care transitions and care coordination. (www.homehealthquality.org) |
| Independent Evaluation Center (IEC) |
| The contractor awarded the IEC contract by CMS; the purpose of the IEC is to evaluate regional and national QIO SOW performance, including annual milestones. |
| 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. |
| Immunization |
| The process of a person becoming immune to a disease, usually through vaccination. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices publishes recommendations for adult immunizations. http://www.cdc.gov/vaccines/schedules/hcp/adult.html |
| Innovation |
| To make changes or to do something in a new way; a new idea, method, or device; a novelty. |
| Intensive Care Unit (ICU) |
| A nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only. Specialty care areas are also excluded. The type of ICU is determined by the kind of beneficiaries cared for in that unit according to the 80% rule. That is, if 80% of beneficiaries are of a certain type (e.g., beneficiaries with trauma), then that ICU is designated as that type of unit (in this case, trauma ICU). |
| Interoperable |
| The IEEE Standard Computer Dictionary defines interoperability as “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.” |
(http://www.healthit.gov/buzz-blog/meaningful-use/interoperability-health-information-exchange-setting-record-straight/)
| Intervention Effectiveness Measurement Strategy |
| A strategy to measure the effectiveness of interventions by providers, practitioners, and facilities based on QIN-QIO work. Typically, the strategy is based on and measures at least four distinct interventions represented across Community Coalitions with a specified goal for improvement. Also, improvement is typically measured at the community level and measures can be used to track and trend whether the intervention implemented had the intended impact on the root cause being targeted. Other key elements in a Strategy include measureable interventions, the identification of a realistic level of change, demonstrable results, and progress management. (Adapted from CDC’s Program Evaluation Tip Sheet) |
| Intervention Effectiveness Reach |
| Reach is the extent to which an intervention or program spreads to its intended audience. Key considerations include scoping the intervention at multiple levels (people, organizations, communities, etc.), calculating a proportion of the population reached, and defining a geographic area. (Adapted from CDC’s Program Evaluation Tip Sheet) |
| 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.” |
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. QIN-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 QIO 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 QIO 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 QIO 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 a QIO 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. |
| Logic Model |
| An iterative tool providing a framework to revisit throughout program planning, implementation, and evaluation. A logic model engages stakeholders and provides a forum to identify and consider stakeholders' differences and priorities (source: Centers for Disease Control) (http://www.cdc.gov/nccdphp/dnpao/hwi/programdesign/logic_model.htm) |
| Long-term Services and Supports (LTSS) |
| Assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) provided to older people and other adults with disabilities that cannot perform these activities on their own due to a physical, cognitive, or chronic health condition. LTSS includes human assistance, supervision, cueing and standby assistance, assistive technologies/devices and environmental modifications, health maintenance tasks (e.g., medication management and ostomy care), information, and care and service coordination for people who live in their own home, a residential setting, or a nursing facility. Long-term services and supports also include supports provided to family members and other unpaid caregivers. Individuals with LTSS needs may also have chronic conditions that require health/medical services. In a high-performing system, LTSS are coordinated with housing, transportation, and health/medical services, especially during periods of transition among acute, post-acute, and other settings. |
| Meaningful Use (MU) |
| Defined by the Office of the National Coordinator for Health IT as using certified EHR technology to improve quality, safety, efficiency, and reduce health disparities; engage patients and family; improve care coordination, and population and public health; and maintain privacy and security of patient health information. The American Recovery and Reinvestment Act of 2009 (ARRA) Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) establishes incentive payments to qualifying hospitals, providers, and Medicare Advantage Organizations who participate in the Medicare and Medicaid programs to adopt and successfully demonstrate meaningful use of certified electronic health records. |
| 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. |
| Medication Reconciliation |
| A formal process of identifying the most complete and accurate list of medications a beneficiary is taking and using that list to provide correct medications for the beneficiary anywhere within the health care system. |
| Medication Therapy Management |
| As defined by the pharmacy profession in 2004, medication therapy management is a service or group of services that optimize therapeutic outcomes for individual patients. Medication therapy management services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and other clinical services. The Medicare Modernization Act of 2003 required that Medicare Part D insurers provide medication therapy management (MTM) services (MTMS) to selected beneficiaries, with the goals of providing education, improving adherence, or detecting adverse drug events and medication misuse. |
| Million Hearts® initiative |
| This Department of Health and Human Services (HHS) initiative began in September 2011 with the goal to prevent one million heart attacks and strokes. The initiative focuses on improving the ABCS – Aspirin therapy when appropriate, Blood pressure control, Cholesterol management, and Smoking cessation. (www.millionhearts.hhs.gov) |
| National Coordinating Center (NCC) |
| The contractor awarded an NCC contract by CMS; the NCC contractor supports QIOs and the QIO program by serving as a central resource and provides expert level assistance on a given topic or specialty area for QIOs and for the Medicare Quality Improvement Program. The QIOs are responsible for tracking and driving national quality improvement toward a stated national goal. |
| National Healthcare Safety Network (NHSN) |
| The nation’s most widely used healthcare-associated infection tracking system, owned by the CDC. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections. Managed by the Division of Healthcare Quality Promotion (DHQP) at the CDC, the NHSN also allows healthcare facilities to track blood safety errors and important healthcare process measures such as healthcare personnel influenza vaccine status and infection control adherence rates. NHSN enrollment is open to all types of United States healthcare facilities including acute care hospitals, long term acute care hospitals, psychiatric hospitals, rehabilitation hospitals, outpatient dialysis centers, ambulatory surgery centers, and long term care facilities. |
| National Prevention Strategy |
| The National Prevention Strategy, released June 16, 2011, aims to guide the nation in the most effective and achievable means for improving health and well-being. The Strategy prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives. (http://www.surgeongeneral.gov/initiatives/prevention/strategy/). |
| Nursing Home Action Plan (2012) |
| CMS published the Action Plan for Further Improvement of Nursing Home Quality in 2012. It is available at: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/2012-Nursing-Home-Action-Plan.pdf |
| Outreach Item |
| Any item that is given to a target audience at no cost in order to reinforce messages delivered in print, online, or verbal communications. An outreach item may include a nominal giveaway that a QIOs uses to supplement its Integrated Communications activities and that is used to promote behavior changes or to address barriers to behavior change associated with an intervention the QIN-QIO seeks to perform as part of the work of this contract. An outreach item differs from a promotional item (see below) in that the item itself has an inherent and clear connection to the interventions the QIN-QIO is attempting to implement, has meaning to a target audience that can influence the outcome of an intervention (i.e., not targeted to the general public at large), and delivers some message or value to the user that encourages them to change behavior or remove barriers to behavior change. All outreach items must conform to CMS and QIO Program branding guidelines. Furthermore, outreach items achieve at least one of the three objectives of communications for behavior change: 1) initiation and “will building;” 2) engagement and maintenance; and 3) retention and sustainment throughout the life of the QIN-QIO task. |
| Paid Media |
| Any communications tactic that requires the QIN-QIO (or another organization on behalf of the QIO) to pay money or in-kind services to deliver a message to an audience. Paid media are also known as “publicity items” and “advertisements.” Paid media may take a number of forms, including advertisements and advertorials in newspaper, television, radio, and buses or subways; websites (including web banner space purchased) and services such as Google AdWords or others that optimize search engine prominence for a fee; paid endorsements or sponsorships; conference exhibits and displays for which the QIN-QIO pays an exhibition fee; and any signs and billboards for which space is rented for a fee. |
| Partner |
| An organization or entity with which the QIN-QIO 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 QIO, 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 QIN-QIO may have accomplished independently. |
| Patient Activation |
| The skills, knowledge, and confidence essential to managing one’s own health and healthcare. |
| 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 health care 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 health care. |
| 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. |
| Physician Quality Reporting System (PQRS) |
| The 2006 Tax Relief and Health Care Act (TRHCA) (P.L. 109-432) required the establishment of a physician quality reporting system, including an incentive payment for eligible professionals (EPs) who satisfactorily report data on quality measures for covered professional services furnished to Medicare beneficiaries during a specified reporting period. CMS initially referred to this program as the Physician Quality Reporting Initiative (PQRI). Beginning in 2015, a payment adjustment/penalty will apply under the PQRS. |
| 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 QIN-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.
| Primary Care Providers |
| Primary care providers in the context of Regional Extension Centers “includes physicians (Internal Medicine, Family Practice, OB/GYN, Pediatrics) and other healthcare professionals (PA, NP, Nurse Midwife) with prescribing privileges in the following settings, which are prioritized by the program: small group practices (10 or less providers); ambulatory clinics connected with a public or critical access hospital; community health centers and rural health clinics; other ambulatory settings that predominantly serve uninsured, underinsured, and medically underserved populations” (http://dashboard.healthit.gov/rec/ ) |
| 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 QIN-QIOs and QIN-QIO staff, coordinate gaps (in conjunction with NCC), 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. |
| Promotional Item |
| A souvenir, giveaway, imprinted apparel piece, button, or other memento provided to a broad public audience that creates awareness of the corporate entity that conducts QIN-QIO work rather than the work of the Program or the specific objectives and metrics of this contract. A promotional item lacks explicit connection between its intended message and the item user’s ability to change behavior or address change barriers associated with improving healthcare quality. Such an item also fails to achieve at least one of the three aims of the communicating for behavior change: 1) initiation and “will building;” 2) engagement and maintenance; and 3) retention and sustainment throughout the life of the QIN-QIO task. (For instance, giving a pen given to anyone who visits an exhibit at a convention will not build the will needed to recruit faculty for a national healthcare collaborative.) |
| Provider (Provider of Services; Participating 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.” “Participating Provider” refers to providers participating in the QIO program. |
| Quality Assurance and Performance Improvement (QAPI) |
| A data-driven and proactive approach to quality improvement. Activities of this comprehensive approach are designed to involve all members of an organization to continuously identify opportunities for improvement, and address gaps in systems through planned interventions in order to improve the overall quality of the care and services delivered to nursing home residents. QAPI is a requirement for nursing homes in Section 1128I(c) of the Social Security Act, as added by section 6102 of the Affordable Care Act, and facilities will be required to implement a QAPI plan one year after promulgation of the final rule. |
| Quality Improvement Initiative |
| Any formal activity designed to serve as a catalyst and support for quality improvement using proven methodologies. The improvements may relate to safety, healthcare, health and value and involve providers, practitioners, beneficiaries, and/or communities (42 CFR 476.1). |
| Quality of care concern |
| A concern that care provided did not meet a professionally recognized standard of health care. A general quality of care review or a beneficiary complaint review may cover a single or multiple concerns (42 CFR 476.1). |
| 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. |
| Regional Extension Center (REC) |
| The Office of the National Coordinator for Health Information Technology (ONC) has funded 62 Regional Extension Centers (RECs) to help more than 100,000 primary care providers adopt and use electronic health records (EHRs). The purpose is to furnish assistance, education, outreach and technical assistance to help providers in their geographic service areas select and successfully implement certified EHR technology. The Regional Extension Centers are part of the Health Information Technology Extension Program established by Section 3012 of the Public Health Service Act (PHSA), as amended by the American Recovery and Reinvestment Act of 2009 Pub. L 111-5) (ARRA). |
| Relative Improvement Rate (RIR) |
| The absolute improvement divided by the difference between the baseline performance and perfect performance (100%). |
| Service Area |
| *Refer to “Area” |
| Solo Practice (as a Participating Practice in EDC) |
| A solo practice is a medical practice of one full-time physician (that is, one who practices more than 34 hours per week) with a primary specialty designation of General Practice, Family Practice, Internal Medicine or Geriatrics (Geriatrics is usually a Certificate of Added Qualifications earned by either an internist or family physician). Primary specialty designations are self-attested by the physician. |
| Special Innovation Project (SIP) |
| SIPs are initiatives, efforts, and programs rooted in local communities. SIPs are recommended to CMS, through the QIO, by community advocates, organizers, and groups engaged with local health issues. The SIP is intended to address a health issue the community finds acute but is less visible to high level federal analytics. |
| Special Population |
| A “special population” may be defined based on local community characteristics and data that identify a targeted set of beneficiaries with an accompanying defined set of unique needs. Special populations could include, but are not limited to, dual eligible beneficiaries; low income populations; non-English speakers; individuals with physical, intellectual or developmental disabilities; or communities with cultural or geographic boundaries. Specific groups could include individuals with Alzheimer’s disease or related dementia disorders, individuals who are homeless, individuals who are terminally-ill, or individuals with end-stage renal disease. |
| Stakeholders |
| For the purposes of this contract, the term “stakeholder” shall describe the role of any individual or organization outside of the immediate QIN-QIO project team who engages in transactions for mutual benefit or gain. 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 health care 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 other QIOs who given their established expertise would assist a SIP.
| Standardized Infection Ratio (SIR) |
| · A summary measure used to track HAIs at a national, state or local level over time. In HAI data analysis, the SIR compares the actual number of HAIs in a facility or state with the baseline U.S. experience (i.e. standard population), adjusting for several risk factors that have been found to be most associated with differences in infection rates. |
| Statement of Work (SOW) |
| Refers collectively to the breadth of QIN-QIO efforts over the award period. The QIN-QIO Statement of Work encompasses the Base Contract, task orders, background, requirements, schedule of deliverables, measures, and appendices associated with the QIN-QIO contract. |
| Successful Intervention |
| 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 health care quality improvement focus area and collection of specific activities and performance requirements for the QIO. |
| 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. |
| Task Order Request For Proposal |
| TORP is a formal invitation to an IDIQ contractor to submit a proposal to fulfill a need that the agency has identified. The Government will evaluate proposal(s) against established selection criteria specified in the task order RFP. |
| Team Strategies and Tools to Enhance Performance and Beneficiary Safety (TeamSTEPPS™) |
| A systematic approach developed by the Department of Defense (DoD) and AHRQ to integrate teamwork into practice. According to the DoD, TeamSTEPPS™ is designed to optimize patient outcomes by improving communication and other teamwork skills among healthcare providers who reliably deliver safe, high quality care. TeamSTEPPS™ consists of numerous ready-to-use materials and training curricula necessary to successfully integrate teamwork principles into all areas of a healthcare system. |
| 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. |
| Value Modifier Program (Physician Value Modifier; VM) |
| The Physician Feedback/Value-Based Payment Modifier Program provides comparative performance information to physicians as one part of Medicare's efforts to improve the quality and efficiency of medical care. This is achieved by providing meaningful and actionable quality and resource use information to physicians so they can improve the care they furnish, and by moving toward physician reimbursement that rewards value rather than volume. |
Section 3007 of the Affordable Care Act mandated that, beginning in 2015, CMS will apply a value modifier under the Medicare Physician Fee Schedule (MPFS). Both cost and quality data are to be included in calculating payments for physicians.
Physicians in groups of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number will be subject to the value modifier in 2015, based on their performance in calendar year 2013.
All physicians who participate in Fee-For-Service Medicare will be impacted by CMS’s emphasis on reporting quality data through PQRS and by 2017 will be affected by the value modifier.
| Value Incentives and Quality Reporting Center (VIQRC) |
| The purpose of the VIQRC is to support quality measures and data element specification, coordinate hospital quality reporting programs such as standardized processes for data transmission, provide administrative and operational support for the hospital quality program data reporting Q&A tool. |
ACRONYMS
| BFCC NCC |
| Beneficiary and Family Centered Care National Coordinating Center |
| BIPA |
| Benefits Improvement and Protection Act |
| CASPER |
| Certification and Survey Provider Enhanced Reporting |
| CAUTI |
| Catheter-Associated Urinary Tract Infection |
| CCSQ |
| Center for Clinical Standards and Quality, a Center within CMS |
| CDE |
| Certified Diabetes Educator |
| CDI |
| Clostridium Difficile Infection |
| CHW |
| Community Health Worker |
| CLABSI |
| Central Line-Associated Bloodstream Infection |
| CMS |
| Centers for Medicare & Medicaid Services |
| COR |
| Contracting Officer’s Representative |
| DRG |
| Diagnosis-Related Group |
| DSME |
| Diabetes Self-Management Education |
| DSMT |
| Diabetes Self-Management Training |
| EDC |
| Everyone with Diabetes Counts |
| EHR |
| Electronic Health Record |
| EMTALA |
| Emergency Medical Treatment and Active Labor Act |
| FIs |
| Fiscal Intermediaries |
| HCQIS |
| Health Care Quality Information Systems |
| HHS |
| Department of Health and Human Services |
| 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 |
| NCC |
| National Coordinating Center |
| NQS |
| National Quality Strategy |
| 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 |
| QIN NCC |
| Quality Innovation Network National Coordinating Center |
| QIO |
| Quality Improvement Organization |
| RAC |
| Recovery Audit Contractor |
| Racial, Ethnic, and Rural Disparities |
| Defined by OMB and US Census Bureau Criteria in SOW |
| REC |
| Regional Extension Center |
| SIC |
| Strategic Innovation Center |
| SIP |
| Special Innovation Project |
| SIR |
| Standardized Infection Ratio |
| SSA |
| State Survey Agencies |
| TOPS |
| Transmittal of Policy System |
| VIQRC |
| Value Incentives and Quality Reporting Center |
