HPMP and PEPPER

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HPMP and PEPPER

• Overview of the Hospital Payment Monitoring
  Programs (HPMP)
• PEPPER Reports
• Christopher G. Richards, RHIA
• February 6, 2007

This material was prepared by Masspro, the
Medicare Quality Improvement Organization for
Massachusetts, under contract with the Centers
for Medicare Medicaid Services (CMS), an agency
of the U.S. Department of Health and Human
Services. The contents presented do not
necessarily represent CMS policy. 07-66
Pepper-feb
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Objectives

• How PEPPER is organized
• How to read the PEPPER
• CMS target areas
• What to do with this information
• A little technical stuff

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Objectives

• Appreciate how Masspro uses the FATHOM and PEPPER
  reports to
• Target areas at high risk for payment errors,
• Identify trends in payment errors over time,
• Guide additional data analysis, and
• Help develop HPMP activities and projects

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A Little HPMP Background

• National Payment Error Rate (NPE)
• Analysis of national and local data
• CMS approves local projects
• CMS may direct national projects
• Everything aimed at reducing the NPE

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FATHOM

• CMS Loves its acronyms
• ATI

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FATHOM

• Any Three Initials

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FATHOM

• FATHOM STANDS FOR
• First-look Analysis Tool for Hospital Outlier
  Monitoring
• SOME THOUGHT
• Finding All the Tricks Hospital use to Outsmart
  Medicare
• QIO Support Center (QIOSC) provides
  administrative reports to the QIOs through the
  FATHOM

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FATHOM ? PEPPER

• Masspro can analyze statewide data using the
  FATHOM data
• The QIO converts the Fathom data into hospital
  specific reports called

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PEPPER

• PEPPER
• Program for Evaluating Payment Patterns
  Electronic Report

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What is PEPPER

• MS Excel application
• Populated with administrative claims data, NOT
  case review data
• Three fiscal years and most current quarter of
  data available for trending
• Can compare hospitals using statistical outliers

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How did we get to PEPPER

• Hospitals can use PEPPER to guide their auditing
  and monitoring activities related to the
  identification and prevention of payment errors.
• The report is grouped into
  13 target areas.
• Identifies any potential outliers within each
  target area
• About to disseminate Quarter4 FY 2006

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Features of PEPPER
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Features of PEPPER

• PEPPER allows for
• Comparative hospital performance for each CMS
  target area
• Prioritization of most important findings
• Provides counts and rates for target measures
• Statewide rank expressed as a percentile

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PEPPER Some CMS Target Areas

• Utilization Concerns
• One day stays
• Other DRGs common in one day stays (e.g., CHF,
  Chest Pain, Dehydration)
• 3 day stays with D/C to SNF
• DRG Concerns
• Respiratory infections/simple pneumonia

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Features of PEPPER

• Example
• What of all stays are for one-day?
• Average might be 12 nationally
• Inliers might range from 8 to 16
• What is your facility's ? What if its 8?
• What if its 18?

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Rate versus a Percentile

• What specifically is a rate
• What specifically is the percentile
• How do they relate
• How is this easily read in the PEPPER Report
• What are we all most interested in?

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Examples

• Lets look at a sample report

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What Should You Take Away?

• Review and SHARE the reports
• Look For RED Outliers
• (gt75th percentile)
• Focus your analysis
• Keep things simple
• Conduct audits when indicated

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Overall

• Hospitals should monitor their own profiles and
  compare themselves with other providers
• Qnet Exchange registration

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Food for Thought.

• 13 of all Medicare admissions are one-day stay
  (FY 2003)
• Medicare paid 8 billion nationally for one-day
  stays (avg. 5,500 per stay)
• Paid 220,500,000 in Massachusetts
• Look at your one day stay report closely to see
  how you compare to other MA hospitals

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Thats It ANY QUESTIONS?

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Contact InformationChristopher G. Richards,
RHIADRG/Data Analystcrichards_at_maqio.sdps.org78
1-419-2757