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Hospital Quality Data: Issues and Challenges Related to How Hospitals Submit Data and How CMS Ensures Data Reliability

GAO-08-555T Published: Mar 06, 2008. Publicly Released: Mar 06, 2008.
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Highlights

Hospitals submit data on a series of quality measures to the Centers for Medicare & Medicaid Services (CMS) and receive scores on their performance. CMS instituted the Reporting Hospital Quality Data for Annual Payment Update Program (APU program) to collect the quality data from hospitals and report their rates on the measures on its Hospital Compare Web site. For hospital quality data to be useful to patients and other users, they need to be reliable, that is, accurate and complete. The Deficit Reduction Act of 2005 directed CMS to implement a value-based purchasing program for Medicare that beginning in fiscal year 2009 would adjust payments to hospitals based on factors related to the quality of care they provide. This statement provides information on (1) how hospitals collect and submit quality data to CMS and (2) how CMS works to ensure the reliability of the quality data submitted. This statement is based primarily on Hospital Quality Data: HHS Should Specify Steps and Time Frame for Using Information Technology to Collect and Submit Data (GAO-07-320, Apr. 25, 2007) and Hospital Quality Data: CMS Needs More Rigorous Methods to Ensure Reliability of Publicly Released Data (GAO-06-54, Jan. 31, 2006). In preparing these reports, GAO conducted case studies of eight hospitals, and reviewed documents of, and interviewed officials at CMS.

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Data collectionData integrityData transmissionElectronic data processingHealth information architectureHealth resources utilizationHospitalsInformation managementInformation technologyMedical information systemsMedical recordsPerformance measuresQuality assuranceQuality controlReporting requirementsStatistical data