What is CheckPoint?
The Wisconsin Hospital Association developed CheckPoint, a voluntary public reporting
program of hospital quality, safety and service measures. CheckPoint provides reliable data on medical
outcomes and interventions that medical experts agree should be taken for common medical conditions
and surgical procedures that patients recive care for in Wisconsin hospitals.
Why are hospitals providing this information?
Wisconsin hospitals want to be accountable for the care they provide to their
patients, and they want the citizens of Wisconsin to learn more about their own
health care. Consumers need access to facts that can help them make informed health
care decisions. In addition, the data can be used to improve care within hospitals
through benchmarking and sharing of best practices. CheckPoint provides information that,
as close as possible, reflects the actual care provided.
How many hospitals are in CheckPoint?
There are 129 hospitals
that voluntarily participate in the CheckPoint program. This includes all acute
care hospitals in the state plus a few specialty hospitals.
Why would a hospital NOT be in CheckPoint?
At this time, the only hospitals that are not participating in CheckPoint are hospitals
that do not care for the types of patients included in the measures.
Why don't all hospitals have data in all the measure sets?
A hospital may not have data for all measures for several reasons. Not all hospitals treat all patients. Hospitals must decide which measures apply
to them, based on the services that they provide. Not all measures in CheckPoint are relevant for the patient population of every
hospital. For example, some patients may enter a hospital and require additional
services so they are transferred to a second hospital. In these instances, the hospital's report will show "NA - Not Applicable."
Each hospital has a quality improvement plan that determines which types of patients they
will monitor and focus their improvement efforts on. If a hospital determines that they will
not monitor their care in an area where CheckPoint has measures, this hospital will not have
any data to report to CheckPoint for that type of care, and their report will indicate “DNR”
which stands for “Did Not Report”.
Hospitals provide data to the CheckPoint program as they begin to
collect the information. When a hospital adds a new service or when a new measure or measure set is added, some hospitals
will be ready to report, while others will need time to get ready to report. If a hospital is in the process of beginning
to collect the new information their report will indicate “IP”, which stands for “In Progress” until a full four quarters
of data is available for reporting.
What does it mean if the report has a + or – sign instead of a number?
If a hospital has chosen to report a measure that has a low volume their report will include a “+” sign. Many measures
in CheckPoint include patient data that are collected over time. The rates for measures that have less than 25 cases
can be viewed by clicking on the “+" sign in the report to view a trend report for that hospital and measure. Be careful
if you look at the data in this way because very small changes in quality can look like large changes in the rates.
If a hospital did not have any patients that met the criteria for the measure their report will show a “-“ sign. The
criteria are required to increase the chance that the information reported for each hospital is the same. If a patient's
information does not meet these criteria, that case is removed from the measure. On occasion, this will eliminate all
cases from the report for an individual hospital even though they provide that type of care.
What are the measures?
CheckPoint reports measures that help consumers understand how effective
a hospital is at providing care that research indicates will lead to the best outcomes.
Some of the measures focus on the quality of care for specific diagnoses or procedures,
while others track progress towards the use of safe practices.
See “Current Measures Detail” for a list of all current measures
How did you select the measures that are in CheckPoint?
The measures in CheckPoint were selected because they are common reasons to go to
the hospital. The measures in CheckPoint were also selected because they
reflect care that is scientifically proven to increase the chance of a positive outcome.
By giving consumers information, we can help improve
their overall health by sharing with them the kind of care that they should
expect to receive.
What patients are included in the CheckPoint data?
The data in CheckPoint includes all hospital patients that receive care for the
conditions measured, regardless of who pays for the care.
Some data reported in CheckPoint is collected by the Centers for Medicare and Medicaid
Services. The Centers for
Medicare and Medicaid Services (CMS) receives all patient data, not just
data relevant to Medicare patients.
Do these measures screen out patients that should not receive the “usual” care?
Yes. The way that data is collected for each measure removes patients that should not get that specific treatment.
For example, if a patient has an aspirin allergy that patient would
not be included in the measure that requires an aspirin be given.
Is the information only available on the Web site?
Yes. Because the data is updated every few months it would be difficult and costly
to update paper copies of the reports. For those consumers who do not have computers
at home, computers are readily available at public libraries and in hospitals where
people can get help accessing the Web site.
How often is the data refreshed in CheckPoint?
The medical, surgical services, and patient experience data is updated every three months.
The error prevention data is updated every six months. Mortality and volume data is updated annually.
How was the data collected for CheckPoint?
Many of the measures are collected from individual patient charts and submitted
to a third party data system by the hospital staff. Patient experience data are collected through surveys sent to hospital patients after they leave the hospital.
The error prevention data are collected from patient charts and
entered directly into the CheckPoint system by the hospital staff. Other measures, such as mortality, readmissions and
volumes for key procedures are calculated from information that is submitted on hospital billing claims. See Data Collection and Validation for details on how the data for each measure is collected.
Can hospitals report their data in such a way that it looks better than it really
No. As hospitals submit the data for measures related to heart attack, heart failure, pneumonia and surgical care
improvement to the Centers for Medicare and Medicaid Services
(CMS), the data is audited for accuracy at several points in the data submission
process before it is placed in the CheckPoint Web site.
CMS validates the data by reviewing sample charts from the hospital's files. The data is then accessed by the Wisconsin quality improvement
organization, MetaStar, which sends the files to WHA for publication to the CheckPoint Web site. MetaStar is a trusted source of valid
information on hospitals. MetaStar has gathered hospital data for more than a decade, while working with hospitals on projects designed to improve quality.
The mortality and readmission data
is calculated by CMS. An individual hospital doesn't know their rate on
any one measure until they receive a report from CMS. Compare it to taking a test,
and handing it to the teacher. You don't know your grade until you get the test
back. The same is true for the Patient Experience data. Each hospital uses a survey
company who sends out the surveys, calculates the results and then sends the results
to CMS. WHA accesses the data right from CMS, not from the hospital.
The Wisconsin Hospital Association
has developed a validation process for the error prevention data to assure that
it is accurate and collected in a consistent way from hospital to hospital.
What period of time was the data collected?
The strength of CheckPoint is that unlike other reports on hospitals, the
data used is very timely. The medical, surgical service, and patient experience data are updated
every three months (March 15, June 15, September 15, and December 15). The error
prevention data is updated every six months (March 15, September 15). The timeframe
that the data in each report was collected is listed at the top of the report.
Will new measures be added in the future?
New measures are being added to CheckPoint on a regular basis. See
Future Measures to learn more.
Who will use CheckPoint?
CheckPoint may be useful to a variety of health care stakeholders:
- Insurance companies and employers have asked health care providers to publish information
that will be useful in assessing the quality of care received by their members and
- Consumers may use the information for two purposes:
--To select a health plan when their employer gives more than one health plan
--To select a hospital in anticipation of a hospital stay.
- Reporters will use the CheckPoint information to learn more about the hospitals
in their communities.
- Legislators are interested in making sure that consumers have access to quality
and safety information for decision making.
- Hospitals will use the data in CheckPoint for benchmarking their care and identifying
best practice hospitals.
What impact do quality reports have on consumer behavior?
We are in the early stages of consumers taking a more active role in their health
care choices. As people bear more financial responsibility for their health care
through higher deductibles and co-payments, their need for information will increase.
Wisconsin hospitals want to have information about quality and safety readily available
as consumers need it.
What are other states doing?
Wisconsin is viewed as a national leader in voluntary hospital reporting of quality
and safety information. Some states have laws requiring hospitals to report this
What does Better, As Expected and Worse mean in the mortality (deaths) reports?
The expected mortality rate for an illness or procedure is calculated based on each hospital’s case mix, which is the types of
patients they care for. The case mix is risk-adjusted by diagnosis-related group, age, gender and comorbidity, and then compared
to the national average for that same case mix. Their actual mortality rate is then compared to this calculated expected rate of mortality.
If the ratio of a hospital’s actual mortality rate compared with their expected mortality rate falls within the expected range,
the hospital is ranked “As Expected.” If the ratio of a hospital’s actual mortality rate compared with their expected mortality
rate is lower than the expected range, the hospital is ranked "Better". If the ratio of a hospital’s
actual mortality rate compared with their expected mortality rate is higher than the expected range, the hospital is ranked "Worse".
What are the goals of the HCAHPS survey?
The HCAHPS survey is designed to meet three goals:
- To produce information that allows objective and meaningful comparisons of hospitals on topics that are important to consumers;
- Public reporting of the survey results creates new incentives for hospitals to improve their quality of care; and
- Public reporting increases public accountability by providing information on the quality of hospital care provided in return for the payment the hospital receives for that care.
How are the measures in the HCAHPS survey used?
An HCAHPS survey asks each patient surveyed to answer 27 survey questions; 18 of the questions are used to create the measures you
see reported on CheckPoint. Some of the questions are combined to create a summary measure and some of them are reported as individual questions, as listed below:
- Summary measures
– Communication with nurses (Questions 1, 2, and 3)
– Communication with doctors (Questions 5, 6, and 7)
– Responsiveness of hospital staff (Questions 4 and 11)
– Pain management (Questions 13 and 14)
– Communication about medicines (Questions 16 and 17)
– Discharge information (Questions 19 and 20)
- Individual measures
– Cleanliness of hospital environment (Question 8)
– Quietness of hospital environment (Question 9)
- Global measures
– Overall rating of hospital (Question 21)
– Willingness to recommend hospital (Question 22)
The remaining nine measures collect information that helps hospitals understand differences between different types of patients,
such as race and ethnicity. Hospitals use this type of information for work related to improving health care disparities.
How is the HCAHPS survey administered?
The HCAHPS survey data is collected from adult patients 48 hours to six weeks after they leave the hospital.
Participating hospitals use an approved survey vendor that sends out all of the surveys, receives the completed surveys, and tallies all of the results.
Hospitals must survey patients each month of the year. Hospitals may use a random sample of patients, but must submit at least 300 completed surveys per year.
Are the HCAHPS survey results adjusted?
The HCAHPS survey results are adjusted for the mode of survey administration (mail, telephone and/or interactive voice response) and patient characteristics (health status, education, service line, age, ER admission, response percentile, service by linear age interactions, and primary language other than English). For more information about the HCAHPS survey visit www.hcahpsonline.org .