82 FR 48102 - Proposed Standards for the Children's Hospitals Graduate Medical Education Payment Program's Quality Bonus System
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration Federal Register Volume 82, Issue 198 (October 16, 2017)
Health Resources and Services Administration
Federal Register Volume 82, Issue 198 (October 16, 2017)
| Page Range | 48102-48103 | |
| FR Document | 2017-22381 |
[Federal Register Volume 82, Number 198 (Monday, October 16, 2017)] [Notices] [Pages 48102-48103] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2017-22381] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Proposed Standards for the Children's Hospitals Graduate Medical Education Payment Program's Quality Bonus System AGENCY: Health Resources and Services Administration (HRSA), Department of Health and Human Services. ACTION: Request for public comment. ----------------------------------------------------------------------- SUMMARY: This notice seeks public comment on establishing a quality bonus system for the Children's Hospitals Graduate Medical Education (CHGME) Payment Program. The CHGME Support Reauthorization Act of 2013 states that the Secretary may establish a quality bonus system, whereby the Secretary distributes bonus payments to hospitals participating in the program that meet standards specified by the Secretary. The goal of this notice is to seek comment to assist HRSA in the development of the standards, payment structure, and outcome measures for the CHGME Quality Bonus System. DATES: Submit written comments no later than December 15, 2017. ADDRESSES: Written comments should be submitted to Malena Crawford, Public Health Analyst, HRSA, by email ([email protected]) or by fax (301-443-0162). FOR FURTHER INFORMATION CONTACT: Malena Crawford, Public Health Analyst, HRSA, 5600 Fishers Lane, Rockville, MD, 20852, (301) 443-7334. SUPPLEMENTARY INFORMATION: The CHGME Program supports graduate medical education (GME) in freestanding children's hospitals. The program supports the training of primary care pediatricians and pediatric medical and surgical subspecialists. The CHGME Support Reauthorization Act of 2013 makes up to 25 percent of the total amount appropriated annually in excess of $245 million, but not to exceed $7,000,000, available to provide payments to newly qualified hospitals, as defined in section 340E(h) of the Public Health Service Act. The statute additionally states that the Secretary may establish a quality bonus system for CHGME hospitals using any remaining funds after payments are made to newly qualified hospitals. In FY 2017, Congress appropriated $300 million to the CHGME Program. Of this, approximately $4 million in payments were made to newly qualified hospitals. If funding levels and mechanisms remain constant, it is estimated that approximately $3 million may be available annually for the CHGME Quality Bonus System. If the total amount available for the CHGME Quality Bonus System in a fiscal year is less than $2 million, HRSA does not plan to implement the CHGME Quality Bonus System in that year to minimize administrative burden on the hospitals. In this case, the funds would be disbursed to all eligible hospitals (including those newly qualified) according to the CHGME formula payment methodology. HRSA understands the complexities involved in designing a GME quality improvement initiative. The CHGME Quality Bonus System would be the first of its kind for any federal GME payment program and responds to changes occurring in the larger health care arena. For example, the Accreditation Council for GME, one of the prevailing GME accrediting bodies, recently implemented new GME program requirements around patient safety and quality improvement. Many GME programs and stakeholders are working towards establishing GME quality related outcome metrics, but currently no widely accepted metrics exist that have the ability to distinguish between the quality of training provided at different hospitals and training programs. Additionally, clinical outcomes alone may not be appropriate measures for establishing a GME quality improvement initiative. HRSA would like to begin to develop approaches to measure and assess the quality of GME programs using existing data sources initially and then develop new and improved data sources as we learn which are most informative and useful. Quality Bonus Payment in FY 2019--Proposal for Public Comment HRSA is proposing a multi-step implementation in recognition of the changing landscape and the need for additional data. For FY 2019, HRSA proposes a quality bonus system that will initially recognize high- level engagement of CHGME hospitals in state and regional health care transformation, as well as engagement of resident trainees in these activities. HRSA is seeking public comment on the timeline, eligibility, standards, documentation, and payment structure as described below. HRSA is also proposing areas for comment for FY 2020 and beyond. Timeline: HRSA anticipates implementing the proposed CHGME Quality Bonus System standards in FY 2019 payments (project period October 1, 2018, through September 30, 2019). CHGME Hospital Eligibility: HRSA proposes to include all eligible CHGME hospitals, including those newly qualified, as eligible entities for the CHGME Quality Bonus System. Quality Bonus System Standards: The proposed standards are: (1) Demonstration of engagement in state- or regional-level initiatives by a children's hospital to transform pediatric health care to improve access, quality, and cost effectiveness of health care; and (2) demonstration of resident trainee engagement in these activities. HRSA has identified several initiatives involving CHGME hospitals that require a significant level of engagement. These include federally funded efforts such as: Participation in a state Medicaid initiative to improve access, quality, and cost effectiveness of pediatric health care (e.g., a Centers for Medicare & Medicaid Services State Innovation Model Award or other Health Care Innovation Award with a state or regional impact); participation in the HRSA Maternal and Child Health Bureau's Health Care Delivery System Innovations for Children with Medical Complexity Collaborative Improvement and Innovation Network (CoIIN); or, participation in HRSA's Federal Office of Rural Health Policy Rural Health Network Development Grant Program. [[Page 48103]] In addition to the partnerships above, HRSA is seeking comment on state or regional initiatives to consider when establishing the qualifying standards for the CHGME Quality Bonus System, as well as suggestions for how to distinguish between levels of engagement and performance in a meaningful way. Documentation: To receive a quality bonus payment based upon engagement in state- or regional-level pediatric health care transformation, CHGME hospitals would be required to submit a letter from the lead organization, which could include the project director for a HRSA-supported program or the state Medicaid Director, confirming participation by the children's hospital in the program and delineating the roles and responsibilities of the children's hospital in the program activities. In addition, CHGME hospitals would be required to submit a brief narrative statement describing how CHGME trainees are integrated into state- or regional-level pediatric health care transformation activities and the expected benefits for trainees and the health systems served by the children's hospital. HRSA is seeking comment on this proposed approach including opportunities to limit burden and streamline the documentation to determine whether applicants meet standards and distinguish among levels of engagement and performance. Payment Structure: HRSA proposes that CHGME hospitals that meet the standards receive a portion of the available funds for the CHGME Quality Bonus System. HRSA proposes a three tiered payment structure to recognize the different annual payment levels received by CHGME hospitals. Hospitals that meet the Quality Bonus Systems standards will be evenly divided into three tiers based on their combined direct and indirect fiscal year payment amounts, as calculated per the established CHGME program formulas: Tier 1: Hospitals that qualify for the quality bonus payment that are in the lowest third among hospitals that qualify for the quality bonus payment of calculated CHGME annual payments will receive a base payment. Tier 2: Hospitals that qualify for the quality bonus payment that are in the middle third will receive two times the base payment. Tier 3: Hospitals that qualify for the quality bonus payment that are in the highest third will receive three times the base payment. The base payment rate would be determined from the total amount available and the number of hospitals that qualify for the CHGME Quality Bonus System in a fiscal year. HRSA would also seek to recognize the hospital's level of engagement or performance in the bonus amount. HRSA is also interested in gathering views and suggestions on whether any of the existing information that hospitals already report to the Centers of Medicare and Medicaid Services, HRSA, accrediting bodies, and others could be used to measure the performance of GME programs and related health outcomes for FY 2019 or subsequent years. This could be individual measures or combinations of measures that are reported to different entities. Quality Bonus Payment in FY 2020 and Beyond--Areas for Public Comment In future years, HRSA will refine the CHGME Quality Bonus System to reflect the feedback received from stakeholders, as well as advancements in the development of standardized GME quality measures. To that end, HRSA also is requesting comments on several areas of the Quality Bonus System that will be implemented in FY 2020 and beyond. For long-term implementation, HRSA seeks public comments on the following areas: CHGME Hospital Eligibility: HRSA proposes to include all eligible CHGME hospitals, including those newly qualified, as eligible entities for the CHGME Quality Bonus System. Quality Bonus System Measures: HRSA is seeking comment on appropriate GME outcome measures that can assess and distinguish performance in meaningful ways. HRSA is considering several GME outcome measures including resident specialty outcomes (e.g., number of graduates in high need pediatric specialties), resident service outcomes (e.g., service to high need rural or underserved communities), and children's hospital quality outcomes. As noted above, these measures could be existing measures that hospitals already report or new ones that would be developed or improved for use in determining quality bonuses. Data Sources: HRSA is seeking comment on available data sources on which to base the Quality Bonus System. HRSA is requesting comment on data sources that are publicly available, will streamline reporting requirements, and will limit burden on CHGME programs. Tiering of Quality Bonus Payments: HRSA is requesting comments on payment structures to recognize hospitals according to their level of engagement and/or outcomes while also taking into account the different size of GME programs. The goal is for payment structures to recognize the quality of hospitals' programs considering the different circumstances in which different children's hospitals operate (e.g., patient severity, size of training programs, number of specialties trained, etc.) Frequency of Review: HRSA plans to review and update the CHGME Quality Bonus System standards regularly to reflect changes in GME and advances in measuring GME outcomes. Dated: October 5, 2017 George Sigounas, Administrator. [FR Doc. 2017-22381 Filed 10-13-17; 8:45 am] BILLING CODE 4165-15-P
![48102 Federal Register / Vol. 82, No. 198 / Monday, October 16, 2017 / Notices
permit evaluation of possible sources of ADDRESSES: Written comments should different hospitals and training
conflicts of interest. Members will be be submitted to Malena Crawford, programs. Additionally, clinical
invited to serve for terms up to 4 years. Public Health Analyst, HRSA, by email outcomes alone may not be appropriate
FDA will review all nominations (MCrawford@hrsa.gov) or by fax (301– measures for establishing a GME quality
received within the specified 443–0162). improvement initiative. HRSA would
timeframes and prepare a ballot FOR FURTHER INFORMATION CONTACT: like to begin to develop approaches to
containing the names of qualified Malena Crawford, Public Health measure and assess the quality of GME
nominees. Names not selected will Analyst, HRSA, 5600 Fishers Lane, programs using existing data sources
remain on a list of eligible nominees Rockville, MD, 20852, (301) 443–7334. initially and then develop new and
and be reviewed periodically by FDA to SUPPLEMENTARY INFORMATION: The improved data sources as we learn
determine continued interest. Upon CHGME Program supports graduate which are most informative and useful.
selecting qualified nominees for the medical education (GME) in Quality Bonus Payment in FY 2019—
ballot, FDA will provide those freestanding children’s hospitals. The Proposal for Public Comment
consumer organizations that are program supports the training of
participating in the selection process HRSA is proposing a multi-step
primary care pediatricians and pediatric implementation in recognition of the
with the opportunity to vote on the medical and surgical subspecialists. The
listed nominees. Only organizations changing landscape and the need for
CHGME Support Reauthorization Act of additional data. For FY 2019, HRSA
vote in the selection process. Persons 2013 makes up to 25 percent of the total
who nominate themselves to serve as proposes a quality bonus system that
amount appropriated annually in excess will initially recognize high-level
voting or nonvoting consumer of $245 million, but not to exceed
representatives will not participate in engagement of CHGME hospitals in state
$7,000,000, available to provide and regional health care transformation,
the selection process. payments to newly qualified hospitals,
This notice is issued under the as well as engagement of resident
as defined in section 340E(h) of the trainees in these activities. HRSA is
Federal Advisory Committee Act (5 Public Health Service Act. The statute
U.S.C. app. 2) and 21 CFR part 14, seeking public comment on the
additionally states that the Secretary timeline, eligibility, standards,
relating to advisory committees. may establish a quality bonus system for documentation, and payment structure
Dated: October 11, 2017. CHGME hospitals using any remaining as described below. HRSA is also
Anna K. Abram, funds after payments are made to newly proposing areas for comment for FY
Deputy Commissioner for Policy, Planning, qualified hospitals. In FY 2017, 2020 and beyond.
Legislation, and Analysis. Congress appropriated $300 million to Timeline: HRSA anticipates
[FR Doc. 2017–22344 Filed 10–13–17; 8:45 am] the CHGME Program. Of this, implementing the proposed CHGME
BILLING CODE 4164–01–P approximately $4 million in payments Quality Bonus System standards in FY
were made to newly qualified hospitals. 2019 payments (project period October
If funding levels and mechanisms 1, 2018, through September 30, 2019).
DEPARTMENT OF HEALTH AND remain constant, it is estimated that CHGME Hospital Eligibility: HRSA
HUMAN SERVICES approximately $3 million may be proposes to include all eligible CHGME
available annually for the CHGME hospitals, including those newly
Health Resources and Services Quality Bonus System. If the total qualified, as eligible entities for the
Administration amount available for the CHGME CHGME Quality Bonus System.
Quality Bonus System in a fiscal year is Quality Bonus System Standards: The
Proposed Standards for the Children’s
less than $2 million, HRSA does not proposed standards are: (1)
Hospitals Graduate Medical Education
plan to implement the CHGME Quality Demonstration of engagement in state-
Payment Program’s Quality Bonus
Bonus System in that year to minimize or regional-level initiatives by a
System
administrative burden on the hospitals. children’s hospital to transform
AGENCY: Health Resources and Services In this case, the funds would be pediatric health care to improve access,
Administration (HRSA), Department of disbursed to all eligible hospitals quality, and cost effectiveness of health
Health and Human Services. (including those newly qualified) care; and (2) demonstration of resident
ACTION: Request for public comment. according to the CHGME formula trainee engagement in these activities.
payment methodology. HRSA has identified several
SUMMARY: This notice seeks public HRSA understands the complexities initiatives involving CHGME hospitals
comment on establishing a quality involved in designing a GME quality that require a significant level of
bonus system for the Children’s improvement initiative. The CHGME engagement. These include federally
Hospitals Graduate Medical Education Quality Bonus System would be the first funded efforts such as: Participation in
(CHGME) Payment Program. The of its kind for any federal GME payment a state Medicaid initiative to improve
CHGME Support Reauthorization Act of program and responds to changes access, quality, and cost effectiveness of
2013 states that the Secretary may occurring in the larger health care arena. pediatric health care (e.g., a Centers for
establish a quality bonus system, For example, the Accreditation Council Medicare & Medicaid Services State
whereby the Secretary distributes bonus for GME, one of the prevailing GME Innovation Model Award or other
payments to hospitals participating in accrediting bodies, recently Health Care Innovation Award with a
the program that meet standards implemented new GME program state or regional impact); participation
specified by the Secretary. The goal of requirements around patient safety and in the HRSA Maternal and Child Health
ethrower on DSK3G9T082PROD with NOTICES
this notice is to seek comment to assist quality improvement. Many GME Bureau’s Health Care Delivery System
HRSA in the development of the programs and stakeholders are working Innovations for Children with Medical
standards, payment structure, and towards establishing GME quality Complexity Collaborative Improvement
outcome measures for the CHGME related outcome metrics, but currently and Innovation Network (CoIIN); or,
Quality Bonus System. no widely accepted metrics exist that participation in HRSA’s Federal Office
DATES: Submit written comments no have the ability to distinguish between of Rural Health Policy Rural Health
later than December 15, 2017. the quality of training provided at Network Development Grant Program.
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![Federal Register / Vol. 82, No. 198 / Monday, October 16, 2017 / Notices 48103
In addition to the partnerships above, Bonus System in a fiscal year. HRSA structures to recognize the quality of
HRSA is seeking comment on state or would also seek to recognize the hospitals’ programs considering the
regional initiatives to consider when hospital’s level of engagement or different circumstances in which
establishing the qualifying standards for performance in the bonus amount. different children’s hospitals operate
the CHGME Quality Bonus System, as HRSA is also interested in gathering (e.g., patient severity, size of training
well as suggestions for how to views and suggestions on whether any programs, number of specialties trained,
distinguish between levels of of the existing information that etc.)
engagement and performance in a hospitals already report to the Centers of Frequency of Review: HRSA plans to
meaningful way. Medicare and Medicaid Services, HRSA, review and update the CHGME Quality
Documentation: To receive a quality accrediting bodies, and others could be Bonus System standards regularly to
bonus payment based upon engagement used to measure the performance of reflect changes in GME and advances in
in state- or regional-level pediatric GME programs and related health measuring GME outcomes.
health care transformation, CHGME outcomes for FY 2019 or subsequent Dated: October 5, 2017
hospitals would be required to submit a years. This could be individual George Sigounas,
letter from the lead organization, which measures or combinations of measures Administrator.
could include the project director for a that are reported to different entities.
[FR Doc. 2017–22381 Filed 10–13–17; 8:45 am]
HRSA-supported program or the state
Medicaid Director, confirming Quality Bonus Payment in FY 2020 and BILLING CODE 4165–15–P
participation by the children’s hospital Beyond—Areas for Public Comment
in the program and delineating the roles In future years, HRSA will refine the
CHGME Quality Bonus System to reflect DEPARTMENT OF HEALTH AND
and responsibilities of the children’s
the feedback received from HUMAN SERVICES
hospital in the program activities. In
addition, CHGME hospitals would be stakeholders, as well as advancements Health Resources and Service
required to submit a brief narrative in the development of standardized Administration
statement describing how CHGME GME quality measures. To that end,
trainees are integrated into state- or HRSA also is requesting comments on Advisory Committee on Heritable
regional-level pediatric health care several areas of the Quality Bonus Disorders in Newborns and Children
transformation activities and the System that will be implemented in FY
expected benefits for trainees and the 2020 and beyond. For long-term AGENCY: Health Resources and Service
health systems served by the children’s implementation, HRSA seeks public Administration (HRSA), Department of
hospital. HRSA is seeking comment on comments on the following areas: Health and Human Services (HHS).
this proposed approach including CHGME Hospital Eligibility: HRSA ACTION: Notice of meeting.
opportunities to limit burden and proposes to include all eligible CHGME
hospitals, including those newly SUMMARY: In accordance with the
streamline the documentation to Federal Advisory Committee Act, notice
determine whether applicants meet qualified, as eligible entities for the
CHGME Quality Bonus System. is hereby given that a meeting is
standards and distinguish among levels scheduled for the Advisory Committee
of engagement and performance. Quality Bonus System Measures:
HRSA is seeking comment on on Heritable Disorders in Newborns and
Payment Structure: HRSA proposes
appropriate GME outcome measures Children (ACHDNC). This meeting will
that CHGME hospitals that meet the
that can assess and distinguish be open to the public but advance
standards receive a portion of the registration is required. Please register
available funds for the CHGME Quality performance in meaningful ways. HRSA
is considering several GME outcome online at http://
Bonus System. HRSA proposes a three www.achdncmeetings.org/ by 12:00 p.m.
tiered payment structure to recognize measures including resident specialty
outcomes (e.g., number of graduates in Eastern Time on November 6, 2017.
the different annual payment levels Information about the ACHDNC can be
received by CHGME hospitals. Hospitals high need pediatric specialties), resident
service outcomes (e.g., service to high obtained by accessing the following
that meet the Quality Bonus Systems Web site: https://www.hrsa.gov/
standards will be evenly divided into need rural or underserved
communities), and children’s hospital advisorycommittees/mchbadvisory/
three tiers based on their combined heritabledisorders/index.html.
direct and indirect fiscal year payment quality outcomes. As noted above, these
measures could be existing measures DATES: The meeting will be held on
amounts, as calculated per the
established CHGME program formulas: that hospitals already report or new Wednesday, November 8, 2017, 9:30
Tier 1: Hospitals that qualify for the ones that would be developed or a.m. to 5:00 p.m. Eastern Time and
quality bonus payment that are in the improved for use in determining quality Thursday, November 9, 2017, 9:30 a.m.
lowest third among hospitals that bonuses. to 3:00 p.m. Eastern Time (meeting
qualify for the quality bonus payment of Data Sources: HRSA is seeking times are tentative).
calculated CHGME annual payments comment on available data sources on ADDRESSES: This meeting will be held
will receive a base payment. which to base the Quality Bonus in-person at 5600 Fishers Lane, 5th
Tier 2: Hospitals that qualify for the System. HRSA is requesting comment Floor Pavilion, Rockville, MD 20857.
quality bonus payment that are in the on data sources that are publicly The meeting will also be accessible via
middle third will receive two times the available, will streamline reporting Webcast. Instructions on how to access
base payment. requirements, and will limit burden on the meeting via Webcast will be
Tier 3: Hospitals that qualify for the CHGME programs. provided upon registration. Please note,
ethrower on DSK3G9T082PROD with NOTICES
quality bonus payment that are in the Tiering of Quality Bonus Payments: the 5600 Fishers Lane building requires
highest third will receive three times the HRSA is requesting comments on security screening on entry. Visitors
base payment. payment structures to recognize must provide a driver’s license,
The base payment rate would be hospitals according to their level of passport, or other form of government-
determined from the total amount engagement and/or outcomes while also issued photo identification to be granted
available and the number of hospitals taking into account the different size of entry into the facility. Non-US Citizens
that qualify for the CHGME Quality GME programs. The goal is for payment planning to attend in person will need
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Document Created: 2017-10-14 01:42:32
Document Modified: 2017-10-14 01:42:32
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Request for public comment. | |
| Dates | Submit written comments no later than December 15, 2017. | |
| Contact | Malena Crawford, Public Health Analyst, HRSA, 5600 Fishers Lane, Rockville, MD, 20852, (301) 443-7334. | |
| FR Citation | 82 FR 48102 |
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