Interpretation and Use of PEPPER
- The values on the Compare Targets worksheet under the headings “Hospital Jurisdict. %ile”, “Hospital State %ile” and “Hospital National %ile” are not the same as the values noted on the respective Comparative Data table of the target area worksheet. Why is there a difference?
The values on the Compare Targets worksheet under the headings “Hospital Jurisdict. %ile”, “Hospital State %ile” and “Hospital National %ile” are not percent values. They represent the hospital’s percentile within the MAC/FI jurisdiction, the state (within that MAC/FI jurisdiction) and the nation for that particular target area for the most recent time period of that PEPPER. The values on the Comparative Data for Target Proportion table of the target area graph worksheet (short-term acute care hospital) and the Comparative Data table of the target area worksheet (LTCH, CAH, IPF, IRF settings) are the percents that are at the jurisdictional, state and national 80th percentile and the jurisdictional, state and national 20th percentile (for coding-related target areas) thresholds for that particular target area for that time period. The Compare Targets worksheet is the only place in PEPPER where a hospital can see its MAC/FI jurisdictional, state and national percentile for the most recent time period of each target area. View a demonstration (Word file, updated 10-01-2011) Compare Targets report, with associated hospital target area data and graph.
- Where can I find more information to help me understand the difference between “percent” and “percentile”?
View a slide presentation (PPT file, updated 7-11-2013) on percents and percentiles.
- Why is there no data, or very little data, for some of the target areas on our PEPPER?
There may be time periods and in some cases entire data tables that do not display any hospital data. The Centers for Medicare & Medicaid Services (CMS) data restrictions prevent the display of numerators and denominators with values that are less than 11. Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
- Why is there no or very little DRG data showing on our Hospital Top Medical DRGs for One-Day Stay Discharges, Hospital Top Surgical DRGs for One-Day Stay Discharges, Jurisdiction Top 20 Medical DRGs for One-Day Stay Discharges and/or Jurisdiction Top 20 Surgical DRGs for One-Day Stay Discharges reports?
No or very little DRG data on the Hospital Top Medical DRGs for One-Day Stay Discharges, Hospital Top Surgical DRGs for One-Day Stay Discharges, Jurisdiction Top 20 Medical DRGs for One-Day Stay Discharges, and/or Jurisdiction Top 20 Surgical DRGs for One-Day Stay Discharges report for a short-term acute care hospital PEPPER (and similar Top DRG reports for LTCH, CAH and IPF PEPPERs) would indicate that there were fewer than 11 one-day stay discharges for any one DRG for the time period of the report. New CMS data restrictions prevent the display of DRG discharge counts that are less than 11. Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
- Are MACs, FIs or RACs given access to individual hospital PEPPERs?
MACs, FIs and RACs are not provided with PEPPERs; however, they are able to generate PEPPERs for hospitals in their jurisdiction using the First-look Analysis Tool for Hospital Outlier Monitoring (FATHOM).
- It would be helpful to have complete data files for the MAC jurisdiction and state to allow our hospital to run its own data comparisons. Can this be done?
PEPPER includes the 80th percentile outlier boundaries and 20th percentile outlier boundaries (coding-focused target areas only) for all time periods for all three comparison groups so hospitals can compare their target area percents with all three comparison groups. Currently national-level data and state-level data for critical access hospitals are available on our Data page. Jurisdiction-level data are not available. PEPPER statistics are considered sensitive information; therefore, hospital data cannot be shared with other hospitals.
- Where can I find PEPPERs, and are they free?
PEPPERs are distributed to short-term acute care, critical access, inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs) that are distinct part units of acute care hospitals and some long-term acute care hospitals that previously had QualityNet accounts, via My QualityNet, which is the only method CMS has approved for the electronic transmission of confidential data. PEPPERs for the above noted settings are distributed to hospital QualityNet administrators and hospital staff who have a QualityNet basic user account with the PEPPER Recipient role. PEPPERs for free- standing IPFs and IRFs are distributed as paper copies, mailed to the CEO/ Hospital Administrator. View more information on PEPPER distribution and QualityNet Accounts. PEPPER is available to hospitals free of charge.
- What data are included in PEPPER, and what is the source of the data?
Short-term (ST) and Long-term (LT) Acute Care Hospital, Critical Access Hospital, Inpatient Psychiatric Facility (IPF) and Inpatient Rehabilitation Facility (IRF) PEPPER User’s Guides are available on the respective Training & Resources pages. The User’s Guides contain detaied information describing what types of claims are included in PEPPER, definitions of the target area numerators and denominators and specifications for the DRG reports. The source of the data is the Medicare PPS Inpatient Hospital Discharge Data.
- The PEPPER file name displays as “Q2FY11,” and the most recent time period in the report is noted as Q2 FY 2011. What does the reference to Q2 FY 2011 mean?
As an example, the short-term acute care hospital PEPPER distributed in August, 2011 includes reportable data from Q3 FY 2008 (third quarter of the federal fiscal year 2008) through Q2 FY 2011 (second quarter of the federal fiscal year 2011). The federal fiscal year begins October 1 and ends September 30. The PEPPER version Q2 FY 2011(named based upon the most recent time period in the report) contains data for hospital discharge dates (paid, inpatient claims) from April 1, 2008 (Q3 FY 2008) through March 31, 2011 (Q2 FY 2011). For subsequent releases of ST PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added.
- How can I get my short-term (ST) acute care hospital’s data for PEPPER versions Q1FY09 and Q2FY09?
There were no PEPPERs generated for Q1FY09 and Q2FY09. The final ST PEPPER version Q4FY08 was released in January 2009 by TMF Health Quality Institute (TMF) under the now defunct Hospital Payment Monitoring Program (HPMP). That release contained data through Q4 FY 2008. TMF negotiated a new contract with CMS’ Office of Financial Management to continue developing and distributing the PEPPER, and the initial PEPPER release in 2010, which does contain some changes in target areas, was distributed in February 2010. There were no PEPPERs developed and distributed during the interim. Each ST PEPPER released will include the most recent 12 federal fiscal year quarters, and the first version released under this new contract, named Q3FY09, included discharges from Q4 FY 2006 through Q3 FY 2009. For subsequent releases of ST PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added. The ST PEPPER User’s Guide, located on the Training & Resources page, contains detailed information describing what types of claims are included in ST PEPPER, definitions of the target area numerators and denominators and specifications for the DRG reports.
- Is PEPPER available for critical access hospitals or specialty hospitals such as psychiatric, rehabilitation?
PEPPER is now available for critical access hospitals, inpatient psychiatric and rehabilitation facilities, as well as short-term and long-term acute care inpatient prospective payment system hospitals. View the PEPPER distribution schedule for more information.
- Can I receive the PEPPERs for several hospitals within our system?
TMF is contracted to provide PEPPERs to individual hospitals across the nation. The technical, security and confidentiality constraints of our distribution system do not allow us to send multiple PEPPERs to one entity, such as someone in a corporate system office. It will be up to each hospital to determine how PEPPER is distributed internally within their facility or to a corporate office. Another option for hospitals that receive their PEPPER electronically through QualityNet is to work with each hospital’s QualityNet Administrator to obtain a QualityNet basic user account (PEPPER recipient role and File Exchange and Search role) at each hospital; you would then be able to receive those facilities' reports. Visit our QualityNet Accounts page for more information.
- What is my MAC/FI jurisdiction, and how many hospitals are included in the MAC/FI and state comparison groups?
Your MAC/FI jurisdiction can be identified in the file name of your hospital’s PEPPER; the five digits following your hospital’s provider number indicate the MAC/FI jurisdiction number. For example, the file name will be xxxxxx_yyyyy_xtPEPP_qxFYxx_hospitalname.xls, where “xxxxxx” represents the hospital provider number and “yyyyy” represents the MAC/FI number. Short-term and critical access hospital PEPPERs also include the MAC/FI jurisdiction name on the Jurisdiction Top 20 Medical DRGs for One-Day Stay Discharges and Jurisdiction Top 20 Surgical DRGs for One-Day Stay Discharges worksheets in the title (row 3). To view a list of the MAC/FI jurisdictions, which includes the number of hospitals in each jurisdiction in total and by state, please visit the Training and Resources page for your particular setting.
- I know there are more than 15 hospitals in Texas; however, this report (Excel file, updated 10-21-2011) indicates this is the number of hospitals in Texas for the Wisconsin Physician Services jurisdiction. Can you explain?
Currently there are ten contractors processing claims for all hospitals in the nation, and hospitals within a given state may submit their claims to a number of different contractors. For example, claims for short-term acute care hospitals in Texas are processed by Noridian Administrative Services, Trailblazer Health Enterprises, First Coast Service Options, Highmark Medicare Services and Wisconsin Physician Services. In developing the new PEPPER, CMS asked TMF to establish the comparison groups according to Medicare Administrative Contractor (MAC) jurisdictions; however, at this time the transition from Fiscal Intermediaries (FIs) to MACs is not complete. Therefore, TMF developed the PEPPER MAC/FI jurisdictions according to contractor, aligning as closely as possible to the MAC jurisdictions that will be in place once the transition is complete.
The CMS website describes the transition from FIs to MACs: “As required by section 911 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), CMS is replacing its current claims payment contractors—fiscal intermediaries and carriers—with new contract entities called Medicare Administrative Contractors (MACs). Currently there are fifteen of these contracts that cover the majority of Part A and Part B services, i.e., “A/B MACs” View a map of the 15 A/B MAC jurisdictions (PDF file). CMS is planning to eventually consolidate the current 15 A/B MACs for a total of 10 A/B MACs. View a map of the 10 consolidated A/B MAC jurisdictions (PDF file).
As the transition to MACs is completed, the PEPPER MAC/FI jurisdictions will evolve to mirror the 10 MAC jurisdictions. Once the transition to the MACs is complete, all hospitals within a given state (in this example Texas) should submit their claims to the same MAC (Trailblazer Health Enterprises for Texas) and therefore be in the same MAC jurisdiction (J4 for Texas) as well as in the state comparison group.
QualityNet or Downloading Issues
- Why did I receive the PEPPER file twice? Which one should I download?
PEPPERs are uploaded by an automated process to those at short-term, some long-term, critical access hospitals, inpatient psychiatric and rehabilitation facilities (IPFs and IRFs) that are distinct part units of an acute care hospital, who are QualityNet Administrators and also to those who have the QualityNet basic user account (PEPPER Recipient role and File Exchange and Search role). If you received the file twice, you are a QualityNet Administrator and have the PEPPER Recipient role as well. The files are the same. You can download one, make sure it opens okay, and delete the other from your My QualityNet inbox if you wish. You will always receive two files if you have been assigned both roles (QualityNet Administrator and PEPPER Recipient). Alternatively, if you don't want to receive the file twice, you can maintain the QualityNet Administrator status and "un-assign" the PEPPER Recipient role within My QualityNet.
- How can I get set up with a My QualityNet account to receive PEPPERs?
You should work with your hospital’s QualityNet Administrator (this is the person who is usually involved in the reporting of your hospital’s quality data), who can assist you with completing the necessary paperwork to set up the basic user account (PEPPER Recipient role and File Exchange and Search role). Please check the “PEPPER Recipient ” and “File Exchange and Search” boxes on the form when selecting roles.
If you are with a short-term acute care hospital, critical access hospital, or inpatient psychiatric or rehabilitation facility that is a distinct part unit of an acute care hospital, and your hospital does not have a QualityNet Administrator, a QualityNet Administrator account must be created through your hospital’s state Quality Improvement Organization (QIO). A directory of all QIOs is available on the QualityNet website. Users must be individually approved and verified. You should contact your QIO to request a QualityNet Administrator registration packet. Instructions for completing and submitting the packet are available on our QualityNet Accounts page. Once your completed registration materials have been received by the QIO, the QualityNet Administrator there will enter your registration information and forward the original registration materials to the QualityNet Help Desk. You will be notified by e-mail when the registration process is complete and the My QualityNet (the secure portion of the QualityNet) website is accessible. The e-mail will also contain your User ID. The QIO's QualityNet Administrator will notify you of your initial password.
- My ‘My QualityNet’ account has been deactivated due to non-use; how can I re-activate it?
If you have not connected to My QualityNet for more than 120 days, then your account may be locked “due to inactivity.” You will need to work with your hospital's QualityNet Administrator (this is the person who is usually involved in the reporting of your hospital's quality data) to submit an account re-activation request to the QualityNet Help Desk. If you were a QualityNet Administrator, another QualityNet Administrator at your hospital can submit the request. If there are no other QualityNet Administrators available at your hospital, then you will have to contact your state’s QIO and work with the QIO's QualityNet Administrator to submit the request.
- I forgot my password to get into My QualityNet. Can you help me reset my password so I can get the PEPPER?
Unfortunately, we are unable to directly reset your My QualityNet password. Your first option is to click on the “Forgot Your Password?” link on the My QualityNet sign-in page. Enter your user ID and e-mail address and click “Submit”. You will need to answer three of the randomly selected security questions to receive a temporary password via e-mail. If this process does not work, or your account is locked, you will need to contact your organization’s QualityNet Administrator to request a temporary password. If you do not have access to a QualityNet Administrator at your hospital, you will need to contact a QualityNet Administrator at your state’s QIO.
- When I log in to My QualityNet I don’t see the PEPPER.
When you log in to My QualityNet, click on the Exchange Files "Send/Receive" link, and at your inbox, you may see a name you don’t recognize (example: “Dan McCullough”) under the From column, “Auto Route Delivery” under the Subject column and a date such as “08/23/2011” under the Date Received column. After clicking once on that row, it turns yellow and you should be able to see the PEPPER file name below, an Excel file that begins with your hospital Medicare provider number (currently referred to as the CMS Certification Number (CCN)) and has the format xxxxxx_yyyyy_xtPEPP_qxFYxx_hospitalname.xls, with xxxxxx as the provider number and yyyyy indicating the MAC/FI jurisdiction. Click in the box to the left of the PEPPER file name and click the Download button in the lower left-hand corner. A message will pop up warning you that if you proceed you will overwrite any file on your computer with the same name; answer “YES,” then choose a folder or location where you want the file to be downloaded, and click “Save.” The PEPPER file should then be saved to your computer.
- I am having trouble downloading the PEPPER.
View instructions for downloading PEPPER, which include the following resources:
a. Step-by-step downloading instructions (PDF)
b. November 2010 information from QualityNet regarding My QualityNet Configuration Changes (PDF)
c. Proxy/Firewall and Uploading/Downloading Troubleshooting Tips (PDF)
Although Java 1.5 meets the minimal configuration requirements from QualityNet, Java version 1.6 or higher works best for the download process.