70558 Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices 

27FDIC, ‘‘FDIC Model Safe Accounts Pilot Final 

Report,’’ (April 2012). 

template of important elements for such 

lending.27 The FDIC encourages banks 

to continue to offer these products, in a 

manner consistent with safety and 

soundness and other supervisory 

considerations, and encourages other 

banks to consider offering such 

products. Properly managed smalldollar loan products offered with 

reasonable terms and at a reasonable 

cost do not pose the same level of 

supervisory risk as deposit advance 

products. The FDIC encourages banks to 

develop new or innovative programs to 

effectively meet the need for smalldollar credit that do not exhibit the risks 

associated with deposit advance 

products and payday loans. 

Dated at Washington, DC, this 21st day of 

November, 2013. 

Federal Deposit Insurance Corporation. 

Robert E. Feldman, 

Executive Secretary. 

[FR Doc. 2013–28306 Filed 11–25–13; 8:45 am] 

BILLING CODE 6714–01–P 

FEDERAL DEPOSIT INSURANCE 

CORPORATION 

FDIC Systemic Resolution Advisory 

Committee; Notice of Meeting 

AGENCY: Federal Deposit Insurance 

Corporation. 

ACTION: Notice of open meeting. 

SUMMARY: In accordance with the 

Federal Advisory Committee Act, 5 

U.S.C. App. 2, notice is hereby given of 

a meeting of the FDIC Systemic 

Resolution Advisory Committee (the 

‘‘SR Advisory Committee’’), which will 

be held in Washington, DC. The SR 

Advisory Committee will provide 

advice and recommendations on a broad 

range of issues regarding the resolution 

of systemically important financial 

companies pursuant to Title II of the 

Dodd-Frank Wall Street Reform and 

Consumer Protection Act, Public Law 

111–203 (July 21, 2010), 12 U.S.C. 5301 

et seq. (the ‘‘Dodd-Frank Act’’). 

DATES: Wednesday, December 11, 2013, 

from 8:45 a.m. to 3:45 p.m. 

ADDRESSES: The meeting will be held in 

the FDIC Board Room on the sixth floor 

of the FDIC Building located at 550 17th 

Street NW., Washington, DC. 

FOR FURTHER INFORMATION CONTACT: 

Requests for further information 

concerning the meeting may be directed 

to Mr. Robert E. Feldman, Committee 

Management Officer of the FDIC, at 

(202) 898–7043. 

SUPPLEMENTARY INFORMATION: 

Agenda: The agenda will include a 

discussion of a range of issues related to 

the resolution of systemically important 

financial companies pursuant to Title II 

of the Dodd-Frank Act. The agenda may 

be subject to change. Any changes to the 

agenda will be announced at the 

beginning of the meeting. 

Type of Meeting: The meeting will be 

open to the public, limited only by the 

space available, on a first-come, firstserved basis. For security reasons, 

members of the public will be subject to 

security screening procedures and must 

present valid photo identification to 

enter the building. The FDIC will 

provide attendees with auxiliary aids 

(e.g., sign language interpretation) 

required for this meeting. Those 

attendees needing such assistance 

should call (703) 562–6067 (Voice or 

TTY) at least two days before the 

meeting to make necessary 

arrangements. Written statements may 

be filed with the SR Advisory 

Committee before or after the meeting. 

This SR Advisory Committee meeting 

will be Webcast live via the Internet at 

http://www.vodium.com/

MediapodLibrary/

index.asp?library=pn100472_fdic_

SRAC. This service is free and available 

to anyone with the following systems 

requirements: http://www.vodium.com/

home/sysreq.html. Adobe Flash Player 

is required to view these presentations. 

The latest version of Adobe Flash Player 

can be downloaded at: http://

www.adobe.com/shockwave/download/

download.cgi?P1_

Version=ShockwaveFlash. Installation 

questions or troubleshooting help can be 

found at the same link. For optimal 

viewing, a high speed Internet 

connection is recommended. The SR 

Advisory Committee meeting videos are 

made available on-demand 

approximately two weeks after the 

event. 

Dated: November 21, 2013. 

Federal Deposit Insurance Corporation. 

Robert E. Feldman, 

Executive Secretary, Federal Deposit 

Insurance Corporation. 

[FR Doc. 2013–28304 Filed 11–25–13; 8:45 am] 

BILLING CODE 6714–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Review of Proposed Changes with 

ICD–10–CM/PCS; Conversion of 

Quality IndicatorsTM (QIs) 

AGENCY: Agency for Healthcare Research 

and Quality (AHRQ), HHS. 

ACTION: Notice of request for public 

comments. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) seeks 

comments on the proposed conversion 

of the AHRQ Quality IndicatorsTM to 

‘‘International Classification of 

Diseases, 10th Edition, Clinical 

Modification/Procedure Coding System’’ 

(ICD–10–CM and ICD–10–PCS) codes. 

These changes would be applicable to 

hospital discharges occurring on or after 

October 1, 2014. The proposed ICD–10– 

CM/PCS codes are posted on the AHRQ 

QI Web site for review at: http://

www.qualityindicators.ahrq.gov/icd10/

default.aspx 

DATES: Comments on this notice must be 

received no later than 5 p.m. EDT of 

December 26, 2013. 

ADDRESSES: Comments can be filed via 

email or on paper. Write ‘‘AHRQ QI 

ICD–10 Conversion’’ on the comments. 

Postal mail addressed to AHRQ is 

subject to delay due to security 

screening. As a result, AHRQ 

encourages submission of comments via 

email. Please submit email comments 

to: QIComment@AHRQ.hhs.gov. 

If comments are filed on paper, write 

‘‘AHRQ QI ICD–10 Conversion’’ on such 

comments and on the envelope, and 

mail them to the following address: Pam 

Owens, Scientific Lead, AHRQ QI 

Program, Center for Delivery, 

Organization and Markets, Agency for 

Healthcare Research and Quality, 540 

Gaither Road, Rockville, MD 20850. 

AHRQ will remove all identifying 

information from the comments and 

will not provide individual responses. 

AHRQ will provide a summary of 

comments and actions taken as a result 

of those comments. The summary 

document will be posted on the AHRQ 

QI Web site no later than the end of 

January 2014. 

FOR FURTHER INFORMATION CONTACT: Pam 

Owens, Agency for Healthcare Research 

and Quality, Center for Delivery, 

Organization and Markets, 540 Gaither 

Road, Rockville, MD 20850, Email: 

pam.owens@AHRQ.hhs.gov, Phone: 

(301) 427–1412. 

SUPPLEMENTARY INFORMATION: A 

structured approach was adopted for 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 228 / Tuesday, November 26, 2013 / Notices 70559 

converting the existing AHRQ QI 

specifications from ICD–9–CM to ICD– 

10–CM/PCS, incorporating coding 

expertise, clinical expertise, and health 

services research/quality measurement 

expertise. This process is summarized 

in a document available for review at: 

http://www.qualityindicators.ahrq.gov/

Downloads/Resources/Publications/

2013/ICD-10%20Report%2007-15- 

2013.pdf 

Each current AHRQ QI technical 

specification with ICD–9–CM codes 

must be converted to ICD–10–CM/PCS 

codes. In each AHRQ QI technical 

specification, there can be one or more 

clinical concepts of selected ICD–9–CM 

codes for the numerator, denominator, 

and exclusion specifications. These 

clinical concepts are called ‘set names,’ 

and they represent the basic foundation 

or building blocks in the construction of 

the AHRQ QIs. Every set name, whether 

diagnosis or procedure, must be mapped 

and reviewed for its clinical 

relationship to the clinical concept used 

within the current QI technical 

specification. 

Following consensus guidance from 

the National Quality Forum (http://

www.qualityforum.org/Publications/

2010/10/ICD-10-CM/PCS_Coding_

Maintenance_Operational_

Guidance.aspx), AHRQ’s process for QI 

conversion in 2012 and 2013 included 

the following components: 

1. ‘‘Convene Clinical and Coding 

Experts: * * *use a team approach that 

involves experts in the code sets and the 

appropriate clinical domain. The team 

should be used to identify specific areas 

where questions of clinical 

comparability exist, evaluate 

consistency of clinical concepts, and 

ensure appropriate conversion. Experts 

are needed in both the source and the 

target code set (e.g., ICD–9–CM and 

ICD–10–CM/PCS). Clinical expertise 

should be in the care setting represented 

by the clinical domain for the measure 

and may require specialized knowledge 

in some clinical areas.’’ To this end, 

AHRQ contracted with clinical and 

coding experts at the University of 

California Davis and convened ten 

workgroups with a total of 27 

physicians, 22 nurses, 26 coding 

professionals, and 9 QI data users in the 

following domains: Cancer, Cardiac, 

Critical Care/Pulmonary, Infection, 

Internal Medicine, Neonatal/Pediatric, 

Neurology, Obstetrics and Gynecology, 

Orthopedic, General and Trauma 

Surgery. Work group members were 

trained on the ICD–10 code sets and 

supported by at least two American 

Health Information Management 

Association (AHIMA)-approved ICD– 

10–CM/PCS Trainers. 

2. ‘‘Determine Intent: When 

converting a quality measure from ICD– 

9–CM to ICD–10–CM/PCS, rather than 

doing a code-to-code conversion, a 

measure developer may choose to take 

advantage of the added granularity and 

specificity [that] ICD–10–CM/PCS 

offers, potentially making the updated 

measure inherently different* * * [T]he 

most ideal way to convert code sets for 

quality measures would be to examine 

the original intent of the measure and 

select codes directly from the target 

code set to define the concepts rather 

than relying on mapping alone* * * (1) 

The measure steward’s goal was to 

convert this measure to a new code set, 

fully consistent with the intent of the 

original measure; (2) The measure 

steward’s goal was to take advantage of 

the more specific code set to form a new 

version of the measure, but fully 

consistent with the original intent; (3) 

The measure steward has changed the 

intent of the measure.’’ AHRQ adopted 

approaches (1) and (2) in the current 

conversion effort. Specifications 

consistent with (1) are called ‘‘legacy 

specifications’’ and are offered for 

historical analyses that require maximal 

comparability over time. Specifications 

consistent with (2) are called ‘‘enhanced 

specifications’’ and are offered for use in 

analyses of current health care quality, 

including public reporting and other 

accountability applications. 

3. ‘‘Use Appropriate Conversion Tool: 

When converting from ICD–9–CM to 

ICD–10–CM/PCS, for example, maps 

such as General Equivalence Maps 

(GEMs) can be useful for narrowing the 

choice of target codes* * *’’ GEM files 

were the foundation of AHRQ’s code 

mapping effort. 

4. ‘‘Assess for Material Change: 

Measure developers should determine 

during the process whether the measure 

has materially changed based on the 

intent of the updated measure and any 

testing that has been performed . . . 

This step is intended to address the 

comparability of the converted measure 

(using ICD–10–CM/PCS) to its 

predecessor (using ICD–9–CM) . . . 

Measure sponsors also should assess, if 

possible, whether the conversion results 

in rates that are similar within defined 

tolerances . . . ’’ This work will be 

undertaken over the next year as dual 

coded data becomes available for 

testing. AHRQ welcomes suggestions 

regarding dual-coded (ICD–9–CM and 

ICD–10–CM/PCS) data that may be 

available for testing purposes in early 

2014. 

5. ‘‘Solicit Stakeholder Comments: 

Conversion to new code sets requires 

involvement of many stakeholders; 

measure developers should solicit 

comments from a wide audience for 

additions and deletions, and with 

specific attention to new codes.’’ This 

notice represents one component of 

AHRQ’s comprehensive effort to solicit 

and respond to stakeholder comments. 

6. ‘‘Version the Updated Measure: 

Measures with coding updates should 

be identified by version. Different 

versions of measures may be used 

longitudinally for various purposes but 

may not be exactly comparable.’’ This 

final step will be implemented when the 

updated AHRQ QI specifications have 

been tested and are ready for public use, 

not later than October 2014. 

For additional information about the 

AHRQ QIs, please visit the AHRQ Web 

site at http://

www.QUALITYindicators.AHRQ.gov. 

Background 

The AHRQ Quality Indicators (AHRQ 

QIs) are a unique set of measures of 

health care quality that make use of 

readily available hospital inpatient 

administrative data. The AHRQ QIs are 

provider- and area-level quality 

indicators and currently consist of four 

modules: The Prevention Quality 

Indicators (PQI), the Inpatient Quality 

Indicators, the Patient Safety Indicators 

(PSI), and the Pediatric Quality 

Indicators (PDIs). The AHRQ QIs serve 

multiple purposes, including research, 

needs assessments for planning at the 

local, state, and national levels, hospital 

quality improvement initiatives, 

performance assessment for public 

reporting to enable consumers to make 

more informed choices about their sites 

of care, public reporting to reward 

favorable outcomes and encourage 

changes in provider behavior, and 

information to be used by healthcare 

purchasers that link performance with 

payment. Users of the AHRQ QIs vary 

and include researchers, State data 

organizations, hospital systems and 

networks, hospital associations, State 

Medicaid agencies, Centers for Medicare 

& Medicaid Services (CMS), large 

private purchasers and public-private 

purchaser coalitions, and consumer 

groups. 

AHRQ is committed to converting the 

AHRQ QIs from ICD–9–CM to ICD–10– 

CM/PCS in an accurate and transparent 

manner, taking advantage of the 

additional specificity of ICD–10–CM/

PCS to improve the validity and 

usefulness of the QIs from October 2014 

onward. 

Dated: November 13, 2013. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2013–28282 Filed 11–25–13; 8:45 am] 

BILLING CODE 4160–90–P 


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