Clinical Quality Measures (CQMs) for Meaningful Use & PQRS
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This presentation provides information on reporting clinical quality measures (CQMs) for Meaningful Use and PQRS, while also providing detailed information on the quality measure specifications that Practice Fusion currently supports. Practice Fusion is a free, web-based, 2014 certified complete ambulatory EHR. www.practicefusion.com/signup/
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Clinical Quality Measures (CQMs) for Meaningful Use & PQRS
- 1. Measuring & Monitoring Clinical Quality Measures Using Practice Fusion Presented By: Emily Richmond, MPH – Senior Mgr. Health Care Quality www.PracticeFusion.com
- 2. Clinical Quality Measures & Quality Improvement + Clinical quality measures, also called CQMs, are tools that help us measure and monitor the quality of healthcare and the contribution of those healthcare services towards improved health outcomes. "If you cannot measure it, you cannot improve it." Lord Kelvin (1824-1907) 2
- 3. CQM Terminology Denominator •The population of patients or encounters for which the measure applies. Numerator • The population of patients from the denominator who meet the measure specified clinical requirements or the population of encounters from the denominator where the measure specific requirement has been performed. Exclusions & Exceptions Measuremen t period •Specifications that would remove a patient from the denominator of a specific quality measure. •Includes certain diagnoses that make it clinically unnecessary for the patient to receive the numerator clinical action and/or provider or patient determined reasons for refusing certain clinical actions. • This is also known as the EHR reporting period and refers to the time frame for which the CQMs will be calculated.
- 4. CQM Terminology National Quality Strategy (NQS) Domains National Quality Forum (NQF) •The six NQS domains, one of which is assigned to each CMS eCQM, are: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, and Clinical Processes/Effectiveness •NQF reviews, endorses, and recommends use of standardized quality measures. Not all quality measures are “NQF-endorsed,” but those that are have an assigned NQF number. Value sets • Lists of specific values (terms and their codes) derived from single or multiple standard vocabularies used to define clinical concepts (e.g. patients with diabetes, clinical visit, reportable diseases) used in clinical quality measures and to support effective health information exchange. Quality Reporting Document Architecture (QRDA) • An HL7-based standard document format for reporting clinical quality measure data to CMS for quality improvement programs.
- 5. Quality Measurement Development Process Coded values that make up Value Sets Groups of Value Sets make up the criteria for the denominator and numerator Value sets are used to create measure logic 5
- 6. Reporting CQMs for Quality Improvement Programs + Multiple CMS Quality Improvement Programs require that providers report clinical quality measure data on a regular basis. + Reporting CQM data does not mean that certain thresholds must be met, but providers must report the required number of measures for each program and meet other program requirements such as including measures that meet certain number of National Quality Strategy (NQS) quality domains. 6
- 7. Reporting CQMs for MU – Stage 1 & Stage 2 Requirement: Report at least 9 measures covering at least 3 of the NQS domains. REPORTING OPTIONS: + Manual reporting during attestation  Provider will type in values from the CQM report exactly as they appear in the EHR at the end of your 90-day reporting period  Zero values (0/0) are acceptable and will not prevent you from achieving Meaningful Use + Electronic reporting at the end of the calendar year  Reporting period will be a full calendar year (January 1, 2014 – December 31, 2014)  Practice Fusion will report data in January 2015 on your behalf for providers who request this. Your MU attestation payment will be delayed until after your CQM values are reported to CMS.  May qualify for PQRS reporting as well if all measures meet PQRS reporting requirements. 7
- 8. Reporting for PQRS using the EHR Reporting Mechanism Requirement: Report at least 9 measures covering at least 3 of the NQS domains. EHR CQMs must be the most recent measure versions available from CMS. • In order to use the EHR reporting option for PQRS, a provider must report on at least 1 measure for which there is Medicare patient data. • Measures with a zero value denominator cannot be used for PQRS. • The PQRS measurement period length is a full calendar year, so for 2014 it would run from January 1, 2014 through December 31, 2014. • Providers who submit CQMs via Meaningful Use attestation can still use electronic submission with Practice Fusion for the purposes of 2014 PQRS reporting in January 2015. • PF will begin accepting requests for electronic submission of CQM data for both PQRS and Meaningful Use in the Fall of 2014. 8
- 9. Practice Fusion Clinical Quality Measures Individual Measure Deep Dive This presentation contains suggested workflow information and examples of data entry that may receive credit for individual CQM calculations. These suggestions and examples are not intended to represent all eligible workflows for meeting the measure criteria. 9
- 10. CMS 165v2 – Controlling High Blood Pressure Denominator Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period Practice Fusion Suggested Workflow Numerator Patients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period. Record blood pressure in the chart note for all patients who have a diagnosis for hypertension during each encounter. Patients whose blood pressure is uncontrolled should be monitored and have their vital signs updated at each follow-up visit. 10
- 11. CMS 165v2 – Controlling High Blood Pressure 1/1/2014 CQM Measurement Period 6/1/2014 12/31/2014 Patients diagnosed with hypertension prior to the start of the measurement period whose hypertension is resolved before the start of the measurement period ARE NOT included in the denominator. Patients diagnosed with hypertension prior to the start of the measurement period whose hypertension is still ACTIVE after the start of the measurement period ARE included in the denominator, if they have an encounter during the measurement period. All patients who are diagnosed with hypertension within the first 6 months of the measurement period and have an encounter during that time ARE included in the denominator. All patients with an active diagnoses for hypertension who have an encounter during the measurement period ARE included in the denominator of the measure. More Measure Details + This measure looks to see that providers can control the BP of their hypertensive patients within the first 6 months of diagnosis. + Patients whose hypertension was diagnosed more than 6 months from the most recent encounter, or patients who were diagnosed with hypertension before the start of the measurement period (meaning before January 1, 2014) will not be included in the denominator of this measure. 11
- 12. CMS156v2– Use of High-Risk Medications in the Elderly Denominator Numerator Patients 66 years and older who had Numerator 1: Patients with an order for at least one a visit during the measurement period high-risk medication during the measurement period. Practice Fusion Suggested Workflow Numerator 2: Patients with an order for at least two different high-risk medications during the measurement period. “High-risk” medications are those than can result in adverse events or medications that are clinically inappropriate for seniors. This measure is calculated based on the medications that prescribed to patients who meet the denominator criteria. Patients are identified as having a visit during the measurement period if they have a signed chart note labeled with an encounter type of “office visit.” 12
- 13. CMS156v2– Use of High-Risk Medications in the Elderly More Measure Details + Examples of high risk medications as defined by this measure include certain dosages and strengths of:  Acetaminophen  Butabarbital sodium  Diphenhydramine Hydrochloride  Estrogens + Go to www.ushik.org to download the “High risk medications for the elderly” Value 13 Set to see the full list.
- 14. CMS138v2 Tobacco Use: Screening and Cessation Intervention Denominator Numerator All patients aged 18 years and older Practice Fusion Suggested Workflow Patients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation counseling intervention if identified as a tobacco user. Record a smoking status in the Lifestyle section for all patients and if the patient’s smoking status indicates they are a tobacco user, document a tobacco cessation counseling intervention in the Screenings/Assessments/Interventions section of the chart note. The smoking statuses that are used to identify if a patient is a “tobacco user” are: Current every day smoker; Current some day smoker; Smoker, current status unknown; Heavy tobacco smoker; and Light tobacco smoker. The smoking status of Unknown if ever smoked is not used to determine numerator credit for this measure. 14
- 15. CMS138v2–Tobacco Use: Screening and Cessation Intervention 1) 2) More Measure Details + Examples of smoking cessation interventions that you can choose are “smoking cessation education (procedure)” or “referral to stop smoking clinic (procedure)” + The smoking cessation intervention that is added to the chart can be “performed” or “ordered” and a result is not needed to receive credit for this measure. 15
- 16. CMS130v2 – Colorectal Cancer Screening Denominator Numerator Patients 50-75 years of age with a visit during the measurement period Practice Fusion Suggested Workflow Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria below: • Fecal occult blood test (FOBT) during the measurement period • Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period • Colonoscopy during the measurement period or the nine years prior to the measurement period Colorectal cancer screenings can be recorded in the patient chart in the Screenings/ Interventions/Assessments section or by receiving structured lab results. Patients are identified as having a visit during the measurement period if they have a signed chart note labeled with an encounter type of “office visit.” To record the colorectal cancer screening, search for the screening that the patient received and select the appropriate screening. Use the modal to indicate that the screening was “performed” and the date that the screening occurred. For patients given a Fecal Occult Blood Test (FOBT), they will be included in the numerator once a structured lab result is received in the EHR. 16
- 17. CMS130v2 – Colorectal Cancer Screening 1) 2) More Measure Details + After selecting the appropriate screening, indicate that it was performed and, if needed, select the date of performance if it occurred in the past by another provider. + You can use the comments section to indicate who completed the screening. + CMS requires an actual lab result, where the test can be identified by a LOINC code, when a measure requires a performed FOBT test (or result). 17
- 18. CMS166v3 – Use of Imaging Studies for Low Back Pain Denominator Patients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visit Practice Fusion Suggested Workflow Numerator Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visit The numerator value for this measure is determined after a 28 day period following each relevant encounter. Practice Fusion only uses encounters that are labeled with “Office Visit” in the denominator of this measure. Imaging studies that have been performed should be recorded in the Screenings/ Interventions/Assessments section of the chart note. Practice Fusion will also use imaging results that are sent to the EHR for the purposes of calculating this measure. 18
- 19. CMS166v3 – Use of Imaging Studies for Low Back Pain More Measure Details + This measure looks to see if providers are unnecessarily ordering imaging tests for patients with low back pain. + Examples of eligible diagnoses for “low back pain” include:  Sciatica, unspecified side  Low back pain  Lumbago  Backache, unspecified + Because this measure is looking to see whether an imaging test is performed within 28 days of diagnosis, you will not see any values for this numerator until at least 29 days after the encounter where the patient was diagnosed. 19
- 20. CMS131v2 – Diabetes: Eye Exam Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period Practice Fusion Suggested Workflow Numerator Patients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: • A retinal or dilated eye exam by an eye care professional in the measurement period, or • A negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement period. After performing the required exam or confirming that the patient has received the exam from an eye care professional, search for and record that an “Examination of the retina (procedure)” has been performed in the Screenings/Interventions/Assessments section. 20
- 21. CMS131v2 – Diabetes: Eye Exam More Measure Details + For this measure, the patient must have received the eye exam from an eligible eye professional. + After determining that the patient has had this exam from a eligible eye professional, search and choose the applicable exam, indicate that it was performed and on what date, and if you choose, include a note about the provider in the comments section. 21
- 22. CMS123v2 – Diabetes: Foot Exam Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period Practice Fusion Suggested Workflow Numerator Patients who received visual, pulse and sensory foot examinations during the measurement period This measure requires that the patient receive all three of the foot exams listed in the numerator description. After performing the required foot exams or confirming that the patient has received the exams from another medical professional during the measurement period, search for and record that a “Diabetic foot exam (visual, sensory, and pulse)” has been performed in the Screenings/Interventions/Assessments section of the chart note. This selection is mapped to the coded values for all three required exams. 22
- 23. CMS123v2 – Diabetes: Foot Exam 1) 2) More Measure Details + The data element “Diabetic foot exam (visual, sensory, and pulse)” has been mapped to the coded values for all three exams required for this measure. + Instead of adding each exam individually, after confirming or performing the visual, sensory, and pulse foot exams, select the option highlighted in green above to get credit in the numerator. 23
- 24. CMS122v2 – Diabetes: Hemoglobin A1c Poor Control Denominator Patients 18-75 years of age with diabetes with a visit during the measurement period Practice Fusion Suggested Workflow Numerator Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% This measure uses structured lab results that are received in the EHR to determine whether a patient falls into the numerator. This is an inverse measure, which means that patients who fall into the numerator do not meet the clinical guidelines. Only structured HbA1c lab results that are received in the EHR from a lab connection can be used to calculate this measure. 24
- 25. CMS122v2 – Diabetes: Hemoglobin A1c Poor Control More Measure Details + Only structured lab results that include a valid LOINC code can be used in calculating this measure. Many labs send us local codes for tests, instead of LOINC – which is required for the 2014 CQM specifications. + Practice Fusion is working with our lab partners to map their local codes to official LOINC codes so that we can process results more efficiently. 25
- 26. CMS2v3 Screening for Clinical Depression and Follow-Up Plan Denominator Numerator All patients aged 12 years and older Patients screened for clinical depression on the before the beginning of the date of the encounter using an age appropriate measurement period with at least one standardized tool AND if positive, a follow-up plan eligible encounter during the is documented on the date of the positive screen measurement period. Patients who meet the denominator criteria should be screened for depression using an age-appropriate depression screening instrument. After conducting the appropriate screening record “Adult [or Adolescent] depression screening assessment” in the Screenings Practice /Interventions /Assessments section. If positive, record the Fusion appropriate follow-up plan in the same section. Suggested Workflow Examples of data elements that meet the requirements for a followup plan include “Mental health care education (procedure),” “Referral to psychologist (procedure),” and “Case management follow up (procedure).” 26
- 27. CMS2v3 Screening for Clinical Depression and Follow-Up Plan 1) More Measure Details + After selecting that the screening was performed, you must select the result of depression screening negative or depression screening positive. 2) + If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. + Since zero values are acceptable for MU CQMs, this will not prevent you from attesting successfully. 27
- 28. CMS68v3 Documentation of Current Medications in the Medical Record Denominator All visits occurring during the 12 month reporting period for patients aged 18 years and older before the start of the measurement period Practice Fusion Suggested Workflow Numerator Eligible professional attests to documenting, updating or reviewing the patient’s current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-thecounters, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications’ name, dosages, frequency and route of administration This measure uses a denominator unit of measurement of all encounters for patients age 18 and older, which means that the numerator criteria must be documented for each encounter labeled “Office Visit” or “Home Visit.” To record your attestation that the patient’s current medication list is documented in the chart, select the “Documentation of Current Medications” checkbox under the Quality of Care section. 28
- 29. CMS68v3 Documentation of Current Medications in the Medical Record 1) 2) More Measure Details + This measure requires that you attest at each patient encounter that you have checked the patient’s current medication list and that it is up to date. + Checking this checkbox not only allows you to document this attestation for the purposes of accurate documentation and calculations, it can also be used if you are ever audited to prove that you completed this clinical action. 29
- 30. CMS69v2 Body Mass Index (BMI) Screening and Follow-Up Denominator Denominator 1: Patients age 65 and older… Denominator 2: Patients age 16 through 64 years of age…. before the beginning of the measurement period with at least one eligible encounter during the measurement period NOT INCLUDING encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate Numerator Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter with the BMI outside of normal parameters. 30
- 31. CMS69v2 Body Mass Index (BMI) Screening and Follow-Up Record height and weight for all patients during eligible encounters (encounters labeled “Office Visit” or “Home Visit”); Practice Fusion automatically calculates and records the patient’s BMI. Determine whether the patient’s BMI falls above or below the normal parameters listed below. Practice Fusion Suggested Workflow Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30 Age 18-64 years BMI ≥ 18.5 and < 25 For patients whose BMI falls outside the normal parameters for their age range, record that an appropriate follow-up plan was either ordered or performed in the Screenings/ Interventions/Assessments section of the chart note. After selecting an appropriate follow-up plan, you will need to record the reason for the followup, e.g. “overweight” or “underweight” depending on where the patient falls in relation to the normal parameters. Examples of follow-up plans for BMI management include: “Dietary counseling and surveillance,” “Lifestyle education regarding diet (procedure),” and “Nutrition therapy (regime/therapy).” 31
- 32. CMS69v2 Body Mass Index (BMI) Screening and Follow-Up 1) 2) More Measure Details + After choosing the appropriate counseling or follow-up plan, you can indicate that it was ordered or performed. + You must also select the appropriate reason code – overweight or underweight, to receive credit for this measure. 32
- 33. CMS50v2 Closing the referral loop: receipt of specialist report Denominator All patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period. Practice Fusion Suggested Workflow Numerator Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred. Referrals that occur in the Practice Fusion referral workflow are tracked in the referral tab of the patient chart or the messages section. After receiving a follow-up consultation report from the provider to whom the patient was referred, select the checkbox next to each completed referral to meet the numerator criteria. Referrals that occur outside of Practice Fusion can be recorded by selecting the appropriate referral data element from the Screenings/ Interventions/Assessments section of the chart note. When a consultation report has been received from the provider to whom the patient was referred, this can be logged in a subsequent chart note under the Screenings/ Interventions/Assessments section by recording “Confirmatory consultation report (record artifact).” 33
- 34. CMS50v2 Closing the referral loop: receipt of specialist report More Measure Details + Check the box in the referral tab to indicate that you have received the follow-up report from the provider where you referred your patient. + This checkbox is tied to the appropriate coded values in the database. 34
- 35. CMS90v3 Functional Status Assessment for Complex Chronic Conditions Denominator Numerator Adults aged 65 years and Patients with patient reported functional status assessment older who had two outpatient results (e.g., VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 encounters during the Global Health, PROMIS-29) present in the EHR at least two measurement year and an weeks before or during the initial encounter and the followactive diagnosis of heart up encounter during the measurement year. failure. This measure requires that patients with heart failure are given functional status assessments at least twice a year and that the functional status results be recorded in the EHR at least two weeks before or during the first and Practice follow-up encounter. Fusion Suggested Functional status assessment results can be recorded in the chart note by Workflow searching for and selecting the appropriate functional status assessment result in the Screenings/ Interventions/Assessments section. Data elements for functional status assessments can be found by searching for the assessment name as listed in the numerator description above. 35
- 36. CMS90v3 Functional Status Assessment for Complex Chronic Conditions Denominator Criteria Numerator Criteria Active Diagnosis of Heart Failure Encounter A ≤ 185 days from start of measurement period + and Encounter B ≥ 30 days and ≤ 180 days after Encounter B Functional Status Assessment A ≤ 2 weeks before or during Encounter A and Functional Status Assessment B ≤ 2 weeks before or during Encounter B More Measure Details + Only patients who have at least two encounters (signed chart notes) during the measurement period (after January 1, 2014) and an active diagnosis of heart failure are included in the denominator of this measure. + To be included in the denominator, the patient’s first encounter must have occurred sometime before or within 185 days of the start of the measurement period and the second encounter must be at least 30 days after but no more than 180 days after the first encounter. 36
- 37. More information on clinical quality measures + http://www.practicefusion.com/meaningful-use-criteria-cqms/ + http://www.practicefusion.com/resources/2014-MeaningfulUse-CQM-Calculation-Guide.pdf + www.ushik.org + http://cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/eCQM_Library .html + http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/EP _MeasuresTable_Posting_CQMs.pdf 37
Editor's Notes
- WHAT ARE CLINICAL QUALITY MEASURES? Clinical quality measures, also called CQMs, are tools that help us measure and monitor the quality of healthcare and the contribution of those healthcare services towards improved health outcomes. In the past, quality measures primarily used data that came from claims, but as technology has improved and become more prominent in the healthcare setting, many quality measures now use data that comes from a provider’s electronic health record (EHR). These electronic CQMs (eCQMs) use EHR data to measure health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagement, and population and public health improvement.
- There are a lot of terms used when discussing and understanding quality measures. The definitions below will help you better use this guide to measure and monitor the quality of care that you provide to your patients. Denominator – The population of patients or encounters for which the measure applies. Numerator - The population of patients from the denominator who meet the measure specified clinical requirements or the population of encounters from the denominator where the measure specific requirement has been performed. Exclusion/Exception – Specifications that would remove a patient from the denominator of a specific quality measure. These exclusions and exceptions include certain diagnoses that make it clinically unnecessary for the patient to receive the numerator clinical action and/or provider or patient determined reasons for refusing certain clinical actions. Measurement period – This is also known as the EHR reporting period and refers to the time frame for which the CQMs will be calculated. For more information on determining your CQM reporting period, refer to the reporting requirements at the end of this guide.
- National Quality Strategy (NQS) Domains – The National Quality Strategyoutlines the federal plan to improve the quality of healthcare delivered in the United States and was developed as a result of the Affordable Care Act. The six NQS domains, one of which is assigned to each CMS eCQM, are: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, and Clinical Processes/Effectiveness. Information on what NQS domain applies to which measure is available in the Practice Fusion CQM report and in the Practice Fusion CQM Calculation Guide. National Quality Forum (NQF) – The National Quality Forum reviews, endorses, and recommends use of standardized quality measures. Not all quality measures are “NQF-endorsed,” but those that are have an assigned NQF number. Value sets - Lists of specific values (terms and their codes) derived from single or multiple standard vocabularies used to define clinical concepts (e.g. patients with diabetes, clinical visit, reportable diseases) used in clinical quality measures and to support effective health information exchange. Although there are many uses for value sets, a primary purpose of the value sets is to support the 2014 Clinical Quality Measures prescribed for Meaningful Use. Most of the value sets are therefore used to define the patient populations that should be included in the denominators and in the numerators when computing a clinical quality measure.Quality Reporting Document Architecture (QRDA) – An HL7-based standard document format for the exchange of clinical quality measure data. QRDA reports contain data extracted from electronic health records (EHRs) and other information technology systems. QRDA reports are used for the exchange of CQM data between systems for a variety of quality measurement and reporting initiatives, including Meaningful Use and PQRS. These programs require the submission of QRDA Category I reports, which utilize patient-level data, or QRDA Category III reports, which utilize aggregated patient data.
- The current set of CMS electronic clinical quality measures that can be used for Meaningful Use are much more complex than the quality measures used for the MU program in previous years. The measures included as part of 2014 EHR certification underwent an extensive quality measurement development process that included reviewing evidence, creating the specifications for the patient population and clinical numerator, testing the measure, defining out the data needs to be collected and defined, and going through the national measure endorsement process (usually through the National Quality Forum). The measure specifications that are given to EHR vendors like Practice Fusion include the exact coded values that make up value sets, information on which value sets make up the criteria for the numerator and the denominator, and which value sets are used in creating the measure logic. Because each quality measure has defined value sets that can be used, each measure has very specific data elements that patients must have in their medical record for the denominator and very specific, although sometimes a large set of options, that you as the provider can enter in the EHR in order to receive credit in the numerator. Although it may seem like a checkbox is the easiest option, checkboxes prevent you from recording the care you have provided in a specific and accurate way. As you all know, not all tobacco cessation interventions are the same – because you can now enter in a variety of potential options for indicating that your patients have received a cessation intervention, your medical records – and your patients’ medical records – will not reflect that care more accurately.
- Measuring and monitoring your performance on clinical quality measures is only part of the picture. Reporting clinical quality measures to appropriate organizations is a big part of moving the health care industry away from fee-for-service and towards pay-for-value. For many providers, clinical quality measure reporting comes as part of participating in the Meaningful Use program and/or the Physician Quality Reporting System, or PQRS. These programs are designed to ease providers into the processes of measuring, monitoring, and reporting quality related data to CMS in order to help them track the performance of physicians who are reimbursed under Medicare. Over time, this data will be used to determine reimbursement values. For the purposes of both Meaningful Use and PQRS, it is important to note that there are no percentage thresholds required for participation and reporting, although for PQRS providers must have values in the denominator of the measures they are reporting. For both MU and PQRS, providers have multiple reporting mechanism options that they can choose from depending on their preferences and whether the measures they want to report are supported in Practice Fusion. Today’s webinar will focus more heavily on Meaningful Use CQM reporting, but will touch a bit on PQRS reporting as it pertains to the CQMs that Practice Fusion supports.
- The CQM reporting requirement for Meaningful Use is to report at least 9 measures that cover at least 3 of the National Quality Strategy domains. Under the 2014 Medicare Physician Fee Schedule Final Rule, CMS made some changes to the rules that govern how providers will need to report CQMs for Meaningful Use. There are now two different reporting options available to providers participating in Meaningful Use. The first reporting option is to manually submit CQM values during attestation to CMS. This is a similar process to how CQM values were submitted to CMS in prior years. When you submit CQM data during attestation, you will need to type in the values from the CQM report exactly as they appear in the EHR at the end of your 90-day period. Zero values are acceptable if you do not have 9 CQMs in your Practice Fusion Clinical Quality Measures report with values in the denominator or numerator. Submitting zero values will not prevent you from achieving Meaningful Use and receiving an incentive payment. The second reporting options is electronic reporting of CQMs to CMS. The reporting period for electronic submission of CQM data will be a full calendar year, from January 1st to December 31st of 2014. Practice Fusion will submit CQM data to CMS at the end of the CQM measurement period for providers who choose the EHR reporting mechanism to report CQMs to CMS for the purposes of Meaningful Use. CQM data will be electronically submitted to CMS as a file that meets the HL7 standards for the Quality Reporting Data Architecture (QRDA). Providers who choose the electronic reporting mechanism for Meaningful Use will have their attestation incentive payments delayed until their CQM values have been reported, but those providers can get credit for both MU and PQRS via this one submission, as long as the measures they are reporting meet the PQRS requirement of having values in the denominator and include data for at least one Medicare patient. Practice Fusion will begin accepting requests for providers who wish to have CQM data submitted to CMS in the fall of 2014. We recommend that providers manually attest to CQM values so that MU payments aren’t delayed, but also continue to monitor the full calendar year reporting period for PQRS.
- As in past years, PQRS offers multiple reporting mechanisms: claims, registry, or direct EHR. Practice Fusion will now support electronic reporting for PQRS measures starting this year. Providers who wish to report PQRS via their EHR will be required to report 9 measures covering at least 3 of the National Quality Strategy domains using a certified EHR system that has been certified to the most recent version of the CMS electronic CQMs. Practice Fusion’s CQMs are all certified to the most recent version of the measure specifications. In order to use the EHR reporting option for PQRS, a provider must report on at least 1 measure for which there is Medicare patient data. As in past years, measures with a zero value denominator cannot be used for PQRS. The PQRS measurement period length is a full calendar year, so for 2014 it would run from January 1, 2014 through December 31, 2014.Providers who submit CQMs via Meaningful Use attestation can still use electronic submission with Practice Fusion for the purposes of 2014 PQRS reporting in January 2015.Practice Fusion will begin accepting requests for providers who wish to have CQM data submitted to CMS for the purposes of PQRS in the fall of 2014. For additional information on PQRS reporting in 2014, including information on the alternative reporting mechanisms such as claims-based reporting, please sign up to attend the “Understanding PQRS in 2014” webinar, scheduled for Tuesday, February 4th at 12pm Eastern/9am Pacific. A link to register for this event will be sent via email to all attendees of this webinar after today’s presentation.
- Now that we’ve completed an overview of the CQM requirements for Meaningful Use and PQRS, let’s spend some time diving deeper into each of the 13 quality measures that Practice Fusion currently offers, including the measure specifications and how the data used in the measure calculation is collected in Practice Fusion. For some the measures where we have gotten a lot of questions, we will take a look at where in the EHR to input the data. This presentation contains suggested workflow information and examples of data entry that may receive credit for individual CQM calculations. These suggestions and examples are not intended to represent all eligible workflows for meeting the measure criteria. Before we begin, I’d like to note that Practice Fusion does plan to support additional Meaningful Use and PQRS quality measures in the near future, so if you are interested in measuring and monitoring other CMS quality measures that are not available in Practice Fusion right now, you will start to see us add more data elements to the EHR in the near future and the calculations added for those measures sometime during the middle of 2014. Now, let’s get started with the first measure, Controlling High Blood Pressure.
- CMS has created the 2014 electronic clinical quality measures (eCQMs) to have more rigorous data collection requirements than previous Meaningful Use quality measures. As such, there are some limitations in how Practice Fusion can collect data for purposes of CQM calculations and reporting. An example of this is that CMS requires an actual lab result when a measure requires a performed FOBTtest (or result). While we are working with our lab partners to increase how many send structured LOINC codes to identify these tests, we are also working with those lab partners to map and identify test results that come in with local laboratory codes so that we can properly give credit when we are able to.
- Many of our customers have asked us about whether screenings that are suggested using clinical decision support are required for some specialties. If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. This is perfectly acceptable as it is a known fact that not all specialties will conduct all preventative screenings. Since zero values are acceptable for MU, this will not prevent you from attesting successfully. If you wish, you can turn off the CDS alerts for depression screening in the clinical decision support settings section of the EHR, but make sure you have the minimum amount of alerts enabled as needed for your stage of MU.