Hospital Quality Reporting Feedback Sign-up

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Thank you for your interest in making Hospital Quality Reporting better for everyone!

Sign up here if you are interested in being contacted in the future for: focus groups, usability testing, feedback sessions, or opinion sharing.

We want to hear your feedback so we can improve your experience. Please share a little about yourself so we can talk to you about parts of Hospital Quality Reporting that are relevant to you.

We might not contact you until the team starts working on parts of the system that you use.

Thank you again for taking the time!

Full name *

What is your job title, and what are your responsibilities? *

Are you a:

Hospital Employee (Single Hospital)

Hospital System employee (Network of Hospitals)

Vendor contracting with hospitals

Vendor contracting with CMS

Ambulatory Surgical Center

Other:

Clear selection

How long have you performed this role?

Less than 1 year

5 years or less

10 years or less

15 years or less

20 years or less

Other:

Clear selection

What type of Quality Reporting Program do you report for? Check all that apply. *

Inpatient Quality Reporting Program

Outpatient Quality Reporting Program

Inpatient Psychiatric Facility Quality Reporting Program

PPS-Exempt Cancer Hospitals Quality Reporting Program

Ambulatory Surgical Center Quality Reporting Program

Promoting Interoperability (formerly Meaningful Use)

Other:

Required

How often do you log in to QualityNet Secure Portal? *

Multiple times a day

Daily

Weekly

Monthly

1-6 times a year

Never

Other:

What are the key activities you do on Hospital Quality Reporting/QualityNet Secure Portal?

What time zone do you work in?

Other:

Clear selection

What email address should we use to contact you? *

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