An ad hoc review may be conducted on an endorsed measure at any time if one or more of the following criteria are met:
- the evidence supporting the measure has changed,
- implementation of the measure results in unintended consequences, and/or
- material changes have been made to the measure.
Ad hoc reviews can be requested at any time by any party, as long as there is adequate evidence to justify the review.
Reason for Request:
CMS has updated the following measures with planned readmissions:
- 0330 Hospital 30-day all-cause risk-standardized readmission rate following heart failure hospitalization for patients 18 and older,
- 0505 Hospital 30-day all-cause risk-standardized readmission rate (RSRR) following acute myocardial infarction (AMI) hospitalization,
- 1551 Hospital-level 30-day all-cause risk-standardized readmission rate (RSRR) following elective primary total hip arthroplasty (THA) and total knee arthroplasty TKA), and
- 1789 Hospital-wide all-cause unplanned readmission measure (HWR)
These changes will be divided into two phases. The updated specifications and analyses for planned readmissions for measures 0330, 0505 and 1551 will be provided and reviewed first followed by the hospital-wide all-cause readmission measure* (1780) for the planned readmission algorithm, dry run results, and progress toward harmonization.
About this Review
Justification for Ad hoc Review
Criterion 3: Material changes have been made to a currently endorsed measure (e.g., expansion of a measure to a different population or setting). This is intended as a focused review of the planned readmission algorithms that have been incorporated into each of the condition/procedure specific readmission measures and the modifications to the hospital-wide all-cause readmission measure for the planned readmission algorithm, dry run results, and progress toward harmonization.
Requestor of Ad hoc Review
Centers for Medicare & Medicaid Services (CMS)
Associated NQF Projects
Process
Requests for ad hoc reviews will be considered by NQF on a case-by-case basis and must be justified by specific criteria. NQF staff review suggests that an ad hoc review is justified given the material changes to the measures.
Notice of the ad hoc review will be posted to the NQF web site and a call for nominations for technical experts will be open for no less than 10 business days. The provisional slate of technical advisors will be posted for comment for no less than 10 business days. The selected technical advisors will review the evidence and provide input to the Consensus Standards Approval Committee (CSAC). The ad hoc review requestor and the measure steward are given the opportunity to provide information to the technical advisors and CSAC. Review and comment period for the draft recommendations from the technical advisors will be posted for no less than 10 business days. Given the complexity of the proposed changes, the public comment period will be a standard 30-day public and member comment period. The information will be forwarded to the CSAC (including the assessment of the technical advisors, public and member comments, and input from the measure steward and requester) and CSAC will make a decision on endorsement status and/or specification changes. The CSAC decision is then forwarded to the NQF Board of Directors for ratification followed by a 30-day appeals period. The measures will be subject to a full evaluation/review in its designated maintenance cycle.
Learn more about the NQF ad hoc review process.
Contact Information
For more information, please contact Taroon Amin, MA, MPH or Ashley Morsell, MPH at 202-783-1300 or via email at measuremaintenance@qualityforum.org.
NQF conducted an ad hoc review for the endorsed measures:0330 [Hospital 30-day all-cause risk-standardized readmission rate following heart failure hospitalization for patients 18 and older];0505 [Hospital 30-day all-cause risk-standardized readmission rate (RSRR) following acute myocardial infarction (AMI) hospitalization] and 1551 [Hospital-level 30-day all-cause risk-standardized readmission rate (RSRR) following elective primary total hip arthroplasty (THA) and total knee arthroplasty(TKA)].There have been material changes to a currently endorsed measure (e.g., expansion of a measure to a different population or setting). This was intended as a focused review of the planned readmission algorithms that have been incorporated into each of the condition/procedure specific readmission measures.
The Steering Committee began meeting in November 2012 to evaluate the
submissions and prepare the draft report.
Measures Submitted
The Ad-hoc Review: Planned Readmissions Expert Panel met in person on November 5, 2012. The meeting was open to NQF members and the public.
NOTE: This meeting was originally scheduled to review the updates to the planned readmissions algorithm for NQF #0330, #0505, #1551, and #1789; in addition to a review of the dry run results, and progress toward harmonization for #1789. However, NQF has been notified by the measure steward that #1789 will not be ready for review by the Ad-Hoc Readmissions Panel. Condition-specific measures will still be reviewed.
The measure steward has provided this statement:
“CMS will return to the NQF Ad Hoc Review Committee with the 1789 Hospital-wide Readmission measure dry run results and updates. We are currently reviewing the dry run results and will return to the Committee following complete analysis. In addition, we are working with NCQA to harmonize the two readmission measures, as suggested by the Steering Committee during the expedited consensus development process. Therefore, CMS will not be presenting the 1789 Hospital-wide Readmission measure at the Nov. 5th, 2012 meeting. We will work closely with NQF to update the public on the 1789 Hospital-wide Readmission measure ad hoc review and all opportunities for stakeholder engagement.”
CSAC recommended all of the Planned Readmissions measures.
Review the CSAC meetings
No appeals were filed during this time.
