Program for Evaluating Payment
Patterns Electronic Report

FAQ
 

PEPPER: Frequently Asked Questions

Interpretation and Use of PEPPER

  1. The values on the Compare Targets worksheet under the headings “Jurisdict. %ile”, “State %ile” and “National %ile” are not the same as the values noted on the respective Comparative Data for Target Proportion table of the Target Area worksheet. Why is there a difference?

    The values on the Compare Targets worksheet under the headings “Jurisdict. %ile”, “State %ile” and “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 quarter of that PEPPER. The values on the Comparative Data for Target Proportion table of the Target Area worksheet 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 quarter. 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 quarter of each target area. View a demonstration (Word file) Compare Targets worksheet and Target Area worksheet that includes a Comparative Data for Target Proportion table. View a slide presentation (PPT file) on percents and percentiles.
     
  2. 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. New Centers for Medicare & Medicaid Services (CMS) data restrictions prevent the display of numerators and denominators with values that are less than 11. TMF is now contracted under CMS’ Office of Financial Management, which has different data restriction policies than CMS’ Office of Clinical Standards and Quality (the office that previously had oversight of PEPPER). Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
     
  3. Why is there no MS-DRG data showing on our Top MS-DRG for One-Day Stay or Top Medical MS-DRG for One-Day Stay reports?

    No data on the Top MS-DRG for One-Day Stay or Top Medical MS-DRG for One-Day Stay reports would indicate that there were fewer than 11 one-day stay discharges for any one MS-DRG for the time period of the report. New CMS data restrictions prevent the display of MS-DRG values that are less than 11. TMF is now contracted under CMS’ Office of Financial Management, which has different data restriction policies than CMS’ Office of Clinical Standards and Quality (the office that previously had oversight of PEPPER). Our understanding of the CMS restriction is that it is related to privacy concerns, to prevent the implicit identification of Medicare beneficiary hospital stays.
     
  4. 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).
     
  5. Older PEPPERs included several additional one-day stay DRG categories (nutritional/metabolic, esophagitis/gastroenteritis, heart failure). These were useful indicators for monitoring and internal review. Will they be added to the PEPPER? Will any other categories be added? Also, 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?

    The previous one-day stay target areas that included nutritional/metabolic disorders, esophagitis/gastroenteritis and heart failure were removed from PEPPER effective with the Q3 FY09 version. They were removed as a result of the new data restrictions that prevent the disclosure of data when the numerator or denominator is less than 11. Most hospitals had fewer than 11 one-day stay discharges during a quarter for these DRGs. The target areas in PEPPER will continue to change over time to remain current with areas that are at risk for improper Medicare payments.

    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 are available on the Data page of PEPPERresources.org. Jurisdiction-level and state-level data are not available. PEPPER statistics are considered sensitive information; therefore, hospital data cannot be shared with other hospitals.
     
  6. Where can I find PEPPER reports, and are they free?

    PEPPER is distributed to hospitals via My QualityNet, which is the only method CMS has approved for the electronic transmission of confidential data. PEPPER is distributed to hospital QualityNet administrators and hospital staff who have a QualityNet account with the PEPPER Recipient role. For more information on My QualityNet, please visit PEPPERresources.org. PEPPERs are available to hospitals free of charge.
     
  7. What data are included in PEPPER, and what is the source of the data?

    The Short-term (ST) and Long-term (LT) Acute Care Hospital PEPPER User’s Guides, located at PEPPERresources.org, contain detailed information describing what types of claims are included in PEPPER, definitions of the target area numerators and denominators and specifications for the MS-DRG reports. The source of the data is the Medicare PPS Inpatient Hospital Discharge Data.
     
  8. The PEPPER file name displays as “Q3FY09,” and the most recent quarter in the report is noted as Q3 FY 2009. What does the reference to Q3 FY 2009 mean?

    The PEPPER distributed in February 2010 includes reportable data from Q4 FY 2006 (fourth quarter of the federal fiscal year 2006) through Q3 FY 2009 (third quarter of the federal fiscal year 2009). The federal fiscal year begins October 1. The Q3 FY 2009 contains data for hospital discharges (paid, inpatient claims) from April 1, 2009, through June 30, 2009. For subsequent releases of PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added.
     
  9. How can I get my hospital’s data for Q1 and Q2 FY 2009?

    The final PEPPER released by TMF Health Quality Institute (TMF) that was associated with the now defunct Hospital Payment Monitoring Program (HPMP) was distributed in January 2009. 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, which does contain some changes in target areas, was distributed in February 2010. There were no PEPPERs distributed during the interim. Now each PEPPER released will include the most recent 12 federal fiscal year quarters, and the first version released, named Q3FY09, includes discharges from Q4 FY 2006 through Q3 FY 2009. For subsequent releases of PEPPER, the oldest quarter from the previous release will roll off as the most recent quarter is added. The Short-term (ST) and Long-term (LT) Acute Care Hospital PEPPER User’s Guides, located at PEPPERresources.org, contain detailed information describing what types of claims are included in PEPPER, definitions of the target area numerators and denominators and specifications for the MS-DRG reports.
     
  10. Is PEPPER available for critical access hospitals or specialty hospitals such as psychiatric, rehabilitation or children’s?

    Unfortunately, PEPPER is only available for short-term and long-term acute care inpatient prospective payment system hospitals.
     
  11. Can I receive the PEPPERs for several hospitals within our system?

    TMF is contracted to provide PEPPERs to individual hospitals across the nation. The distribution process involves sending each hospital's specific report to specific individuals at that hospital. The technical, security and confidentiality constraints of our distribution system do not allow us to send multiple PEPPERs to other entities. It will be up to each hospital to determine how PEPPER is distributed internally within their facility or to a corporate office. Another option is to work with each hospital’s QualityNet Administrator to obtain an account at each hospital; you would then be able to receive those facilities' reports.
     
  12. 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 PEPPERs also include the MAC/FI jurisdiction name on the “Jurisd Top 1DS DRGs” and “Jurisd Top 1DS Med DRGs” worksheets in the title (row 3). View a list of all MAC/FI jurisdictions (38kbs Excel file) by number and name, including the number of short-term and long-term acute care hospitals in each jurisdiction in total and by state. 
     
  13. I know there are more than 76 hospitals in Texas; however, this report indicates this is the number of hospitals in Texas for the Wisconsin Physician Services jurisdiction. Can you explain?

    Currently there are eleven 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 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 Web site 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). CMS plans to award a total of 19 MAC contracts through three procurement cycles. Fifteen of these contracts will be with entities that will cover the majority of Part A and Part B services, i.e., A/B MACs.” View a map of the MAC jurisdictions (PDF file).

    As the transition to MACs is completed, the PEPPER MAC/FI jurisdictions will evolve to mirror the 15 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

  1. Why did I receive the PEPPER file twice? Which one should I download?

    PEPPERs are uploaded by an automated process to those who are QualityNet Administrators and then to those who have been assigned the "PEPPER Recipient role, with File Exchange and Search." If you received the file twice, you are a QualityNet Administrator and must have been assigned 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 the 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.
     
  2. 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 complete the necessary paperwork to set up the user account. Please ask her/him to assign the “PEPPER Recipient ” and “File Exchange and Search” roles to the account.

    If 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 CMS MedQIC Web site. Users must be individually approved and verified. You should contact your QIO to request a QualityNet Administrator registration packet, or download a packet from PEPPERresources.org. 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) Web site is accessible. The e-mail will also contain your User ID. The QIO's QualityNet Administrator will notify you of your initial password.
     
  3. 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.
     
  4. 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.
     
  5. 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 “02/04/2010” 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 CCN XXXXXX. 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.
     
  6. I am having trouble downloading the PEPPER.

    Usually the problem is related to the version of Java and/or local area network (LAN) settings on the computer. Start with performing a test of your system by going to the homepage of QualityNet, under “Getting Started with QualityNet” and clicking “Test Your System”. Click the “Test Your System” button at the bottom of the page. If any or all of the tests fail, there are on-screen instructions to follow. If all tests have passed, the problem may be with local area network (LAN) settings. From the Internet Explorer browser, top menu bar, click on “Tools”, then “Internet Options”, then “Connections”, then the “LAN settings” button. If any checkbox is checked in the LAN settings box, uncheck the box(es), close the Internet Explorer browser, and then re-open. Connect to My QualityNet and try to download again. If the download is successful, go back to the LAN settings box and re-check whatever box(es) had been unchecked to return the computer to the normal hospital configuration. If these actions have been taken and you are still having problems downloading the PEPPER, you may need to ask your IT department for assistance. View downloading instructions and tips.