Frequently Asked Questions
Performance Improvement Projects (PIPs)
Validation of Performance Measures (VPM)
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PERFORMANCE IMPROVEMENT PROJECTS (PIPs)
1. What are the Centers for Medicare & Medicaid Services (CMS) Protocols?
The CMS protocols for external quality review (EQR) activities were initially published
in 2002. In September of 2012, CMS released revised versions of all EQR protocols. The
new Version 2.0 of the EQR protocols is available at the Resources link.
2. What is the next step once the PIP Validation Report is received?
Once the MCO receives the PIP validation report from HSAG, the MCO
should ensure that all Points of Clarification, Partially Met, and Not Met
evaluation elements have been addressed on the submitted Summary Form for the next
validation cycle. The MCO will use its existing PIP study Submission Form. This
is a dynamic form and all new
information should be
dated, highlighted, or bolded. The MCOs should strikethrough and date any information
that is no longer pertinent.
Check with your specific contract manager for the timeframe for submitting PIPs
to AHCA and DOEA for review. They are generally due to the State on June 1 of each
year across all MCO types.
3. How long does a PIP study go until it is retired?
Typically, a PIP study will continue until it has had a baseline and at least two
annual measurement periods. Occasionally, methodologies change, which may impact
the length of the study. Or another year may be recommended if sustained improvement
has not been attained and the potential exists with an additional year of data.
4. What if I need PIP training...Where do I go?
PIP 101 training can be found at www.myfloridaeqro.com
on Validation of PIPs
. PIP Summary Forms, documents, and PIP training information
can be found at this location.
5. What are some resources I can use in conducting my PIP?
The resources provided here include websites that offer knowledge and support to
improve health care, evidence-based clinical practice guidelines, examples of case
studies that illustrate principles of quality improvement and resource libraries.
Health Care Quality Improvement Studies in Managed Care Settings (publication): http://www.ncqa.org/tabid/203/Default.aspx
Sampling Calculator: http://www.surveysystem.com/sscalc.htm
Agency for Healthcare Research and Quality: www.innovations.ahrq.gov
Center for Health Care Strategies: www.chcs.org
Institute for Healthcare Improvement: www.ihi.org
National Guideline Clearinghouse: www.guidelines.gov
NCQA Quality Profiles: www.qualityprofiles.org
Statistical testing Calculator: www.graphpad.com/quickcalcs/index.cfm
6. Where can I find information about HEDIS if my PIP is a HEDIS-based improvement project?
For HEDIS-based PIPs, measures, NCQA provides HEDIS technical resource information on its Website at:
7. Who do I contact at HSAG if I have questions about PIPs?
Throughout the process of completing your PIP documentation if you should have any
questions please do not hesitate to contact the HSAG PIP staff.
Christi Melendez, RN, CPHQ
Associate Director, PIP Review Team
Phone number: 602-801-6875
8. When submitting data should I include member level data?
No. When you submit data for your PIP study HSAG is only interested in aggregated
rates for each measurement period. We do not want raw data or data that includes
any personal health information.
9. How do I upload my PIP documents to the file transfer protocol (FTP) site?
HSAG has an FTP site instruction packet that should have been provided to you with
the PIP submission request letter. If you do not have this document or are having
difficulty accessing or uploading to the FTP site, please contact Jenny Montano
either via the phone at 602.801.6851 or email at JMontano@hsag.com
1. What is a collaborative PIP?
A collaborative PIP focuses on a single technical area. It is a time-limited quality
improvement strategy to use pertinent best practices in the achievement of a common
goal. The function of a collaborative PIP is to spread existing expertise across
its participants so that all MCOs have access to topic expertise in all facets of
planning, conducting, and documenting a successful PIP. A collaborative PIP increases
the capabilities in the MCOs and enhances quality outcomes.
2. Who’s doing a collaborative PIP?
The MCOs are separated into four groups, each conducting a separate collaborative
PIP: HMOs and PSNs, PMHPs, SIPPs, and NHDPs. All contracted MCOs are highly encouraged
For more information about Collaborative PIPs, contact Jenny Montano at JMontano@hsag.com
1. What is the purpose of the validation of performance measures activity?
VALIDATION OF PERFORMANCE MEASURES (VPM)
The purpose of the validation of performance measure activity is two-fold: First,
the process ensures that the MCO/PIHP calculated the performance measures according
to the state-required definitions or specifications, which allows MCO/PIHP performance
to be compared with other MCOs/PIHPs. Secondly, the process ensures that the performance
measure results that are reported by an MCO/PIHP are truly valid and accurate, and
appropriately reflect the level of services provided by the MCO/PIHP.
2. Is a HEDIS Compliance Audit™ considered to be a validation of performance
Yes. The BBA requires that the State, the State's agent, or the EQRO validate performance
measures following a method that is consistent with the CMS protocols. The HEDIS
Compliance Audit process is determined to be consistent with the VPM protocol.
3. Where can I get a copy of the protocols?
The CMS protocols for the validation of performance measures are posted on this
website, under the Resources tab.
4. What is an ISCAT?
The ISCAT is the Information Systems Capabilities Assessment Tool, which is Appendix
Z of the CMS protocols. The ISCAT is comparable to NCQA's baseline assessment tool
and is intended to collect information about the information system practices that
are used to collect performance measure data. The ISCAT is typically completed by
the MCO/PIHP annually as a part of the performance measure validation process.
5. Who can I contact with questions about the validation of performance measures?
For any questions related to the validation of performance measures, please feel
free to contact:
David Mabb, MS, CHCA
Phone number: 602.801.6843
HEDIS® Compliance Audit™ is a registered trademark of the
National Committee for Quality Assurance
SUBMIT A QUESTION
If you would like to submit a question to HSAG, please send it via e-mail to: firstname.lastname@example.org