Welcome to the STS-ACC TVT Registry September 2022 Case Scenario. This month, we will discuss star ratings eligibility for public reporting. A site's administration has learned the STS-ACC TVT Registry launched a public reporting initiative and are interested in opting in. They asked the registry site manager for their 2021 star rating report sent via file delivery and were surprised to see they were not awarded a star rating. While juggling numerous tasks and projects, a data analyst, Megan, is asked to explain why. As a data analyst, where would Megan look to assess 2021 facility level eligibility status for public reporting star ratings? Number one, in the TAVR 30-day composite site report sent via file delivery. Number two, metric 336 TAVR 30-day risk standardized mortality morbidity composite detail lines. Number three, STS-ACC TVT Registry public reporting companion guide available on the resource page. Or number four, none of the above. Please take a few moments to review the question prior to making a final selection. And the answer is number two. Megan would look at the detail lines for metric 336 TAVR 30-day risk standardized mortality morbidity composite as this metric is used for public reporting. Question number two, knowing the detail lines of metric 336 TAVR 30-day risk standardized mortality morbidity composite informs eligibility status for 2021 public reporting star ratings, which ending timeframe should Megan review? Number one, 2021 quarter one. Number two, 2021 quarter two. Number three, 2021 quarter three. Or number four, 2021 quarter four. Please take a few moments to review the question prior to making a final selection. And the answer is number four, 2021 quarter four. The TAVR 30-day composite site report for 2021 uses three years of data submitted by the 2021 quarter four data deadline. Therefore, the associated 30-day follow-up detail lines for metric 336 TAVR 30-day risk standardized mortality morbidity composite are available under the TAVR 30-day composite risk model R3Y category under the 2021 quarter four ending timeframe should be used to determine model eligibility and metric performance. This concept will apply to future reports, meaning the TAVR 30-day composite site report for 2022 will use three years of data submitted by the 2022 quarter four data deadline and so on. Now let's visually explain the steps Megan will take to explain why her facility did not receive a star rating. After logging into ncdr.com and accessing the TBT registry e-reports dashboard, she knows to change her view to detail lines, 30-day follow-up, then change her ending timeframe to 2021 quarter four, and finally change her category to TAVR 30-day composite risk model R3Y noted in FAQ ID 25357. Once the dashboard loads her data, she sees the following information in her TAVR 30-day composite risk model eligibility detail lines. Question number three, why did Megan's facility not receive a star rating for 2021? Number one, her facility did not perform enough TAVRs in the R3Y reporting period. Number two, her facility did not perform enough 30-day follow-ups in the R3Y reporting period. Or number three, her facility did not perform enough baseline KCCQs in the R3Y reporting period. Please take a moment to review the detail lines provided before making a final selection. And the answer lies within detail line 11707. Eligibility criteria, baseline KCCQ performed greater than 90% was not met. In this case, it was only met 80% of the time. Thank you for viewing the September 2022 STS ACC TBT registry case scenario. We'll see you next month.

STS-ACC TVT Registry

star ratings eligibility

public reporting

2021 report

metric 336 TAVR 30-day risk standardized mortality morbidity composite