WA-APCD Review & Reconsideration Process

Providers registering now for first performance measures Review
& Reconsideration (R&R) period November 30, 2017 - January 8, 2018

The WA-APCD will hold its first provider performance results review and reconsideration (R&R) process beginning in late November, in advance of the initial launch of provider cost and quality reporting on the new Washington HealthCareCompare website in early 2018.

Medical practices, hospitals, and ambulatory surgery centers can log in to an internet portal to view their quality and/or cost performance results and, if they find any errors, request corrections.

About the WA-APCD

In 2015, the Washington legislature initiated a statewide all-payers health care claims database as a public resource for improving the delivery of health care across the state. Administered by Washington's Office of Financial Management, the WA-APCD, in July 2017, collected its first round of claims and enrollment data submissions from commercial health insurers, Medicare Advantage, and Medicaid plans. This initial data covers the 2013-2016 service period and includes more than 4 million Washingtonians.

What measures will be shown in the public reporting?

Three kinds of metrics will be reported at the practice or facility level:

How to Register

Provider organizations may request a registration invitation by . In registering, each provider organization must designate a staff member to serve as its administrator for the R&R process.

See the FAQ below for common questions on the R&R process.

Frequently Asked Questions

Questions: Provider Organization Registration

What is the purpose of the review and reconsideration (R&R)?

The R&R process is a way for providers -- primary care practices, hospitals, and ambulatory surgery centers and outpatient diagnostics centers -- to review the all-payer performance results that will be used in WA-APCD data products and public reporting and to request corrections if needed. Per Washington's WA-APCD statute (RCW 43.371.060), the R&R process is required to help ensure the accuracy of WA-APCD data products and public reporting.

How do provider organizations register for the R&R?

A provider organization designates a staff member to serve as its point person for the R&R process, called the "R&R Administrator." This person registers by going to the registration website (please to access that site). For medical practices, a staff member whose responsibilities include quality performance measurement and reporting is well suited to this role. For hospitals and ambulatory surgery or outpatient diagnostic centers, a staff member whose responsibilities include commercial payer reimbursement and/or pricing of medical services is well suited to this role.

What if my organization has multiple entities or provider sites, such as a hospital and clinics?

Provider groups and integrated delivery systems have discretion over whether to designate one person or more as R&R Administrators to represent multiple entities or locations.

If the provider organization prefers to have one person coordinate R&R for all sites or entities, that person can register as the R&R Administrator. Once the portal is open, this person can grant access to additional members of the organization to help with the review.

If the provider organization prefers to have different people responsible for different entities or sites, the organization can have different individuals register as R&R administrator for different entities or locations.

In either case, each registrant, when filling out the registration web form, should list the name and address of each site for which s/he will serve as the R&R Administrator. 

When do provider organizations register for the R&R?

To participate in the R&R, providers should register no later than October 6th. Although providers can register after this deadline, their review period may be shorter than the full R&R review period.

Which types of provider organizations are included in the R&R?

Performance data for primary care medical practices, acute care hospitals, ambulatory surgery centers, and outpatient diagnostic centers are included in the R&R process.

Which types of provider organization are NOT included in the R&R?

Specialty hospitals such as rehabilitation centers, children's hospitals, psychiatric hospitals, and cancer centers will not be included in the R&R process.

What is the next step after registration?

Once the provider organization has registered its R&R Administrator, the administrator will receive follow-up information and an orientation to using the R&R portal as the R&R period approaches.

What happens if a provider organization does not participate in R&R?

Provider organizations are not required to participate in the R&R process. If a provider organization chooses not to participate, its data will be incorporated as-is in WA-APCD public reporting and data products.

 

Questions: the R&R process (November 2017 - January 2018)

When can a provider organization use the R&R portal?

The R&R review schedule and login credentials will be sent to the provider organization's registered R&R Administrator. The R&R review will occur during a five-week period going from late November 2017 to early January 2018.

How does a provider organization access the R&R portal?

The provider organization's registered R&R Administrator will receive an invitation and login credentials to enter the portal.

How does a provider organization add authorized staff to use the R&R portal?

Upon login to the R&R portal, the provider organization's R&R Administrator can add additional staff as R&R portal users. As a data confidentiality precaution, the WA-APCD will contact the provider organization to verify these users' identities before they can access the portal.

What performance and patient information is in the R&R portal?

Provider organization portal users first will see a summary measures dashboard showing the organization's quality and cost measure results. The portal user can click on a measure to view the patients included in the measure, and if relevant, the numerator compliance status. If the portal user wishes to record a correction, a "reconsider" button opens the reconsideration information box; the user can select from among a preset list of reconsideration reason codes. Certain reconsiderations require additional information like the date the patient received the service.

What costs are included in the facility cost metrics? 

Cost information shown for hospitals and ambulatory surgery and outpatient diagnostic centers is the total paid amount, which includes the amounts paid by both the insurer and the patient. These are total-episode costs that include facility and professional components. The median, 25th percentile, and 75th percentile costs are reported.

For which medical services will cost metrics be displayed?

Facility-specific cost metrics are reported for about 12 inpatient treatments and 40 outpatient services. The full list of these medical services will be distributed to registered users and available online.

How long does the performance results review take?

A review of the dashboard measures results can be done quickly – the user can assess the congruence of the measure results with the organization's historical quality and price metrics. If the user wishes to review patient-specific details for any number of measures, the review would take considerably longer.

What actions can I take when using the R&R information?

For quality measures, when viewing the patient-specific information, the user can request a reconsideration for any patient listed. For medical practices, practitioners can be removed from the practice list. For price metrics, the provider organization can request reconsideration of a medical service price in instances in which the price materially diverges from prevailing prices. A medical service and its price information can be removed if the provider no longer renders that service.

Will reconsiderations be automatically accepted?

Many but not all reconsiderations will be accepted automatically. The WA-APCD will verify certain reconsideration requests.

When can I see the final performance results after any reconsiderations?

In early 2018, all provider organizations that participate in the R&R review will be notified about the processing of any reconsiderations and the availability of the final performance results.

What are the R&R portal privacy protections?

The identity of each provider organization's registered R&R Administrator and users will be verified through a two-step authentication process to confirm the identity of all persons who are permitted to access the R&R portal.

How often does a provider organization have to do this R&R work?

The R&R process will be conducted annually.

Questions: WA-APCD Quality Performance Measurement and Reporting

What performance information will the WA-APCD report to the public?

The roughly 55 measures that comprise the Washington State Common Measures Set will be reported publicly. A subset of about 30 measures will be reported for medical practices and can be reviewed beforehand in the R&R portal. About 85 provider-specific price metrics will be reported for hospitals and ambulatory surgery centers/outpatient diagnostic centers;these are also available for review in the R&R portal. The 10 hospital quality measures are not reviewable in the R&R portal as they are vetted in other state and national measurement programs.

Which patients are included in the R&R portal performance results?

The performance results are based on Washington fully insured commercial patients, from all health insurers in the state, and on Medicaid enrollees. Patients who are not included in this data include those covered by Medicare and self-insured commercial plans.

What is the source of the performance information?

WA-APCD performance results are calculated from health care claims submitted to the WA-APCD by Washington health insurers and by Medicaid.

When and how will the performance information be available to the public?

Performance metrics will be published on the new WA-APCD website, Washington HealthCareCompare, when the site launches in early 2018. Site visitors can view medical practice and hospital quality measures in addition to facility-specific prices for a set of inpatient, outpatient, and ambulatory services. Quality results also will be reported for geographical regions of the state, including Washington's nine Accountable Communities of Health.

How does the WA-APCD review and reconsideration program differ from the Washington Health Alliance’s program?

The WA-APCD is a state program, created by Washington law (RCW 43.371.060), and its public reporting serves all Washingtonians. The public-reporting consumer website, Washington HealthCareCompare, will be available to the general public, as will be other data products that come out of the WA-APCD program.  Although the WA-APCD review and reconsideration process is a voluntary activity, providers are asked to participate to help ensure the accuracy of information that will be widely used by all stakeholders.

The Washington Health Alliance’s provider review and reporting is a privately run program that is separate from the WA-APCD program.

Who do I contact if I have a question or need more information?

The WA-APCD team can be reached at (503) 494-1454 or