Proposed Standards for the Children's Hospitals Graduate Medical Education Payment Program's Quality Bonus System, 48102-48103 [2017-22381]
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48102
Federal Register / Vol. 82, No. 198 / Monday, October 16, 2017 / Notices
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This notice is issued under the
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relating to advisory committees.
Dated: October 11, 2017.
Anna K. Abram,
Deputy Commissioner for Policy, Planning,
Legislation, and Analysis.
[FR Doc. 2017–22344 Filed 10–13–17; 8:45 am]
BILLING CODE 4164–01–P
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
Health Resources and Services
Administration (HRSA), Department of
Health and Human Services.
ACTION: Request for public comment.
AGENCY:
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.
ethrower on DSK3G9T082PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
16:59 Oct 13, 2017
Jkt 244001
Written comments should
be submitted to Malena Crawford,
Public Health Analyst, HRSA, by email
(MCrawford@hrsa.gov) 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
ADDRESSES:
PO 00000
Frm 00053
Fmt 4703
Sfmt 4703
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 stateor 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.
E:\FR\FM\16OCN1.SGM
16OCN1
ethrower on DSK3G9T082PROD with NOTICES
Federal Register / Vol. 82, No. 198 / Monday, October 16, 2017 / Notices
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
VerDate Sep<11>2014
16:59 Oct 13, 2017
Jkt 244001
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
PO 00000
Frm 00054
Fmt 4703
Sfmt 4703
48103
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
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Service
Administration
Advisory Committee on Heritable
Disorders in Newborns and Children
Health Resources and Service
Administration (HRSA), Department of
Health and Human Services (HHS).
ACTION: Notice of meeting.
AGENCY:
In accordance with the
Federal Advisory Committee Act, notice
is hereby given that a meeting is
scheduled for the Advisory Committee
on Heritable Disorders in Newborns and
Children (ACHDNC). This meeting will
be open to the public but advance
registration is required. Please register
online at https://
www.achdncmeetings.org/ by 12:00 p.m.
Eastern Time on November 6, 2017.
Information about the ACHDNC can be
obtained by accessing the following
Web site: https://www.hrsa.gov/
advisorycommittees/mchbadvisory/
heritabledisorders/.
DATES: The meeting will be held on
Wednesday, November 8, 2017, 9:30
a.m. to 5:00 p.m. Eastern Time and
Thursday, November 9, 2017, 9:30 a.m.
to 3:00 p.m. Eastern Time (meeting
times are tentative).
ADDRESSES: This meeting will be held
in-person at 5600 Fishers Lane, 5th
Floor Pavilion, Rockville, MD 20857.
The meeting will also be accessible via
Webcast. Instructions on how to access
the meeting via Webcast will be
provided upon registration. Please note,
the 5600 Fishers Lane building requires
security screening on entry. Visitors
must provide a driver’s license,
passport, or other form of governmentissued photo identification to be granted
entry into the facility. Non-US Citizens
planning to attend in person will need
SUMMARY:
E:\FR\FM\16OCN1.SGM
16OCN1
Agencies
[Federal Register Volume 82, Number 198 (Monday, October 16, 2017)]
[Notices]
[Pages 48102-48103]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[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 (MCrawford@hrsa.gov) 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