2021.07.14 EQRS Program Working Group Meeting-cancelled due to PI Planning

• Call will be recorded for the purpose of capturing further meeting notes.  Any objections please let it be known

Meeting notes from 6/25 EDI Submission call

Today's discussion - error codes triggered

Roadmap

High Priorities

Timeline

EDI Submitters

Lisa/EDI Submitters

Lisa/EDI Submitters

Ahmar/EDI Submitters

• Question about the following codes
  • 12525    Post-Dialysis Weight is more than 5% greater than the Pre-Dialysis Weight.
  • 13622    Session UF Post-Dialysis Weight is more than 5% greater than the Pre-Dialysis Weight.
    
    • They have found if the error is triggered, it is rejecting the entire clinical file so none of it goes through
    • They would like CMS to tell them what they expect FKC to report for post weight if they will not accept the weight they are trying to send?
    • In past discussions, a range may have been determined on what to see in the future
      • Is there a max range that may be an error?
      • But a mid range that may only be a warning?
      • This may be post phase 3 implementation into production
      • What would CMS like FKC to report for those post weights so they can get clinical data submitted?
      • The program needs to define what the values are, get the values approved and schedule development 
      • Two layers of thresholds were already discussed
        • Clinically feasible range = errors
        • Clinically desirable range = warning
      • May be related to data entry errors
      • FKC not asking the rule be relaxed
    • Due to the length of this discussion, it was recommended to continue this discuss at next Wednesday's Program Working group meeting
  • Details for this discussion can be found in the recording of the meeting:
    • https://zoom.us/rec/share/18xvu2YcMSxZgotv7Ar-1GOTeYSHCrwmkSZXIxAVaXFCm6P3jcxjgPIJHdCllJg._oExdGrbGLTn7VRv Passcode: V6c4s?5g 

• During FKC testing for Phase 3,  two errors were triggered
  • 12525    Post-Dialysis Weight is more than 5% greater than the Pre-Dialysis Weight.
  • 13622    Session UF Post-Dialysis Weight is more than 5% greater than the Pre-Dialysis Weight\
    • Entire clinical file is being kicked out
    • Kathleen is asking CMS for feedback on what they want FKC to report for post weight if they won't accept the post weight they are trying to submit?
    • What should FKC do to get the data in?
    • They did look at the volume triggered or will trigger and it was a very small percent
    • Suggestion from Lisa - for FKC not to submit that value being that it is a small percentage (less than 1%)
    • Expect it to be in small frail people or children
    • Lisa encourages FKC to set up something internally
    • Suggestion to turn this into a warning because it is clinically feasible this could occur blocking a patients data can have an effect on a clinics QIP, some of the data tolerances are so tight
    • If its a warning and its a data error, people can fix it and that data can get into the system
    • DCI does not agree with this scenario
    • FKC is comfortable with Lisa's suggestion/answer
    • CMS is still planning on looking at the capsules of values that are warnings with an outer capsule that is an error; it is still on the backlog
    • FKC asked what is the harm in leaving it as a warning and then changing it to an error?
    • Per Lisa, there is no time to go back and redo it; close to phase 3 signoff
• EQRS PI15 Planning will be July 14th and 15th; the Program Working Group meeting scheduled for July 14th will need to be cancelled.  The next meeting will be July 28
  • In the July 28th meeting
    • Plans for CMS/Program to show roadmap, where they are at and what they are thinking
    • CMS/Program would like to get feedback from the EDI Submitters on what CMS/Program is thinking and what they plan for the future
    • Would like to make EQRS something that works for everybody; what CrownWeb was dreamed to be
    • Davita asked - As for the roadmap, what timeline or what scope would that include?
      • CMS responded - we usually map out 3 months at a time so the
      • July 28th meeting the group should see PI15 and also the next 3 PI's (16,17 and 18) on the roadmap
      • Takes us into 2022 
      • Should be able to show high level epics that have been forecasted
      • Proposed dates associated with features
      • Keep in mind if something else comes up, CMS may need to rearrange things, it's their thought process, vision board

• What would the EDI Submitter groups see as high priorities?
  • DCI (Vlad)
    • Redesign the structure - move away from having to enter all information at one time and allow to enter and submit information individually, at separate times without impacting data that has already been entered/submitted
    • Allow the ability for EDI's to pull data out of CrownWeb - right now they are relying on reports; nice to have an API or some kind of transmission to CrownWeb; this will save a lot of time and having to rely on reports
    • Also would be nice for CMS to provide some kind of year to date QIP score (at least quarterly)
      • Per Ahmar, planning to work on Patient list report and available throughout the year
      • Goal to have the QIP score available throughout the payment year
  • Chris Brown
    • Attempt be made to get to where we thought EQRS was headed when V1 came out
      • Combining various data sources and making some of the data that's available for instance to networks also available to facilities (ie. transplant waitlist information)
      • Also when there is a source of truth that knows what the MBI number or Medicare status is of a patient not to require that to also be submitted from facilities because we know better than they do what the answer to that is and truly make it sort of a seamless system across the various data sources we have
  • Lisa
    • Maybe we can benefit from a dashboard where we can see comparisons and numbers at different levels
    • The dashboards could be built off what CMS is looking for n projects or in QIP.  It may be interesting to facilities to see how they doing towards those project or goals
    • Everyone's input is important and appreciated
    • Want the EDI's to be partners
    • Fairness and collaboration are important
  • Howard
    • A dashboard may not be the way to go and have CMS develop it.  Rather CMS should provide the EDI Submitter an API or some access to be able to get their data out
    • CMS should just provide the data access to the EDIs and its up to them to render the data in a useful way that their facilities can best use it
    • If CMS could give them access to the data they could collaborate on what the dashboard should look like
    • What is the plan for QIP for last year's data?
      • Ahmar - we are waiting on the proposed rule, it is scheduled to be out COB today (6/30), Eastern time
      • Should provide some clarity and it can be discussed at the next Program Working Group meeting

• • Kathleen
    • Received EOCT invitation to next week's townhall to discuss 2020 data resubmission and attestation and depression screening data
    • Is there any information that could be shared today on the timeline of the resubmission for September - December, 2020?
      • Data resubmission for 2020 restarted for September - December (7/12)
      • Have all data submitted into EQRS for 2020 - clinical months closures (9/1)
        • Assuming the start of resubmission on 7/12 
      • If everything goes well with phase 3, start system back up (7/12)
        • That will allow about 48 days to submit the data for calendar year 2020
        • Touchpoint meetings will be held to discuss progress of the submissions and any technical issues they run into
      • This plan aligns with the QIP timeline to have a preview period sometime in October
      • Who will give the EDI submitters the Clinical Compliance report that they receive from the NCC?
        • They do not get on a regular basis, last one was 6/7
      • Request that when system is ready for EDI's to start resubmitting, can Scott's team or whomever send an email indicating Phase 3 is now live in production and they may start resubmissions? (Action Item Scott)
        • Don't want people to resubmit too early
      • Is there an opportunity for them to test attestation batching next week before they try to do it live? (Action Item Scott)
        • Ahmar recommends to talk to Scott's team for guidance
        • It was just announced that attestations are needed, but the system never allowed them in pre-prod or in production environments
        • They never figured out why it didn't work
        • They will test them in pre-prod and want to know who will be able to help troubleshoot if it still does not work
        • They will try to test before Friday
    • Howard
      • Will they have Clinical Compliance reports available to them at least twice a week? (Action Item CMS)
        
        • CMS confirm the report will be available to the EDI Submitters, Monday's, Wednesday's and Friday's
        • It is important that they get that report if they going to meet the aggressive timeline on clinical closing for 4 months
        • This report is something they use with their facilities to tell them how close they are to having their files completed for the month
        • Importantly it a list of patients and what is missing for each of those patients
        • The NCC will need to deliver this report, probably not the ADO
      • Another critical issue is Load Testing
        • They are opening up data for four months and there will be a big rush to get the data in
        • It's important we know at what point the system breaks in terms of load testing
        • The volume that Yvette's team were planning to load test for them were about 50% of what Howards calculation say a monthly load is. It's important they hear that Yvette's team thoroughly perform load testing
        • Howard sent email to Curt, looking for 350 per minute for them, originally it was listed at 150 and his calculations are closer to 350 
    • Kelly
      • Vendors will need the cleaned up error codes list (Action Item Curt/Ahmar)
        • They need the list before they start submitting as a point of reference.  Need to be aware of any changes
        • Yvette said the list of error codes should be delivered by the end of the next iteration or by 7/6; they are also trying to get it delivered to the EDI Submitters before 7/6
        • No objections from the EDI Submitters on receiving the cleaned up error codes list on or before 7/6
      • Request that the team that runs the database, when they do open up the clinical submissions for September through December of 2020 for specified time of 7/12 through 9/1 when it's going to close make sure that the 2021 months are NOT accidentally opened  (Action Item Ahmar) 
        • So if the submitters accidentally send something for 2021, they get an error message right away
        • The database should only signal the 4 months (September through December) are the only months open for clinical submissions
      • Request that when Ahmar meets with Janet and team at NCC to create the clinical compliance report, they do NOT include all the 2021 months of missing data because the report becomes too large
        • Keep the report constrained to the clinical months that they are working on (September through December 2020)
        • Lisa will check to see if that it possible to do
      • In preparation for this window period for the submission of 2020 data, has there been any work done with the support desk and the teams that will support them if they run into any submission problems with their data?
        • Due to the short timeframe, problems will need to be resolved immediately
        • Per Curt, they are already working on it and planning for support to the EDIs if problems occur 
    • Hari
      • Confirming we are not opening up the July 2020 and August 2020 clinical months?  We are just opening from September to December 2020 months
        • Per Ahmar the rationale is because July and August did not have any known system issues; it was business as usual
    • Revathy
      • Wants to confirm for attestations testing, the personnel file is setup in prod-preview the same way they are set up in prod? (Action Item Scott)
      • Pre-prod may have been refreshed with prod data, but Scott  may be the one to answer this question
      • Is depression data also there in pre-prod? They never got a chance to submit their depression data
        • Yes the depression data will be included 

• 7/14 meeting will be cancelled due to PI 15 planning