Exception Request Overview

Summary:

A Hospital Performance/Small Hospital Incentive Program (HPIP/SHIP) exception process has been put in place to allow hospitals a mechanism to formally request a review of measurement targets not achieved during the HPIP/SHIP contracted measurement period. For an exception to be considered, certain requirements must be met and demonstrate a situation which is out of the control of the facility. There is no guarantee that submitting a request will result in an exception being granted.

Criteria for consideration:

• System wide technical issue resulting in extreme unforeseeable barriers
  • Unexpected dissolution of vendor agreement
  • Software viruses
• Achievement of performance target was beyond the control of the hospital
  • Natural disaster including, but not limited to, floods, blizzards, or epidemics
  • Unforeseeable occurrence including, but not limited to, unexpected building construction or fire

Criteria exclusions:

• Staffing
• EMR optimization

Exception Request Requirements:

For each exception to be considered and reviewed, specific requirements must be met.

• An exception form must be completed in full for each measure an exception is requested.
• Provision of the most current data to allow for continual trending. Inclusion of numerators, denominators, rate, and timeframes is required to be submitted as evidence.
• Exception requests require supporting evidence to validate the request and must be submitted with the exception form. Supporting evidence must demonstrate timely process improvement interventions to circumvent the hindrances or correct the unexpected issues. Examples of evidence include:
  • New/improved processes
  • Policies
  • Action plans
• All exception request forms, and related evidence documents must be received at the same time as the final data submission due date to be considered by the exception review committee. Evidence can be sent via email to the Clinical Consultant assigned to your facility.

Actions:

• Health Plan exception review committee will review all exception requests and evidence submitted.
• The Health Plan review committee determination will be final.
• Results of final determination will be communicated by email to the hospital quality contact.