CMS-10431 EBRT Pop Sample Application

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Web-Based Application for Clinical Care Measures

Online Data Entry Tool Content for FY 2017 and Subsequent Years

Overview

This document provides instructions for using the CMS online web application for reporting Population and Sampling data for the External Beam Radiotherapy (EBRT) Measure.

The Population and Sampling application enables a PPS-Exempt Cancer Hospital user or their contracted vendor to enter the population data of Medicare and non-Medicare patients that meet the inclusion criteria for the EBRT Measure set. The user or their contracted vendor can also indicate if they are submitting all of the records that meet the inclusion criteria, or if sending a sample, they can identify the frequency of sampling and the number of records that will be included in the sample.

Accessing the Web-Based Application

The user enters their assigned User ID and password to access the secure site and information for their individual hospital.

*Final web design is subject to change as it is dependent on web real estate and IT capacity. Changes will not impact the data elements but rather the application layout.*

Figure 1 Sign In

Manage Measures

After selecting the “View / Edit Population and Sampling” link under Manage Measures, the user selects the Reporting Period and selects the [Continue] button:

Figure 2 View / Edit Population & Sampling Selections

Sampling Frequency Selection

The user will select the sampling frequency: Quarterly, Not Sampling, or Not Applicable.

Reporting – Initial Inpatient Population and Sample Size

The reporting is identified as Medicare and Non-Medicare.

Sample Frequency: Not Sampled

Not Sampled Patient Population	Number
Total Initial Patient Population
Medicare Initial Patient Population
Non-Medicare Initial Patient Population

Figure 3

Initial Inpatient Population	Quarter 1	Quarter 2	Quarter 3	Quarter 4	Total
Medicare
Non-Medicare
Total
Sample Size	Quarter 1	Quarter 2	Quarter 3	Quarter 4	Total
Medicare
Non-Medicare
Total

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1175. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, and gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26

PCHQR Program 03/05/2014 Page 1 of 2