missouri hospital association meaningful use quality measure update
TRANSCRIPT
Missouri Hospital Association
Meaningful Use Quality Measure Update
Glass Half Full?
Agenda
• Background
Current state
Stage 1 lessons learned
• Stage 2 Meaningful Use
Hospital/CAH
Eligible Professional (EP)
• Certification
• Looking Ahead
Update On EHR Incentive Programs
• Medicare and Medicaid EHR incentive program registrations:– 3,247 Hospitals– About 188,400 Physicians/EPs
• A growing number, but still small share, have been paid for meeting meaningful use requirements– 712 Hospitals (40 CAH)– 22,937 Physicians
• 43 states have opened Medicaid programs
Data from CMS, as of January 2012
Most, but not all, states have now established Medicaid EHR incentive programs
Red = Made Payments (34); Blue = Accepting Registrations (9)Data from CMS as of January 2012
Cost
In 2010, the average capital IT expense per bed was over $12,000, while the average IT operating expense was over $45,000.
Together, hospitals are spending $57,000 a year per bed on IT.
For a 200-bed hospital, that would translate to over
$11.4 million per year.
The Bottom Line
Stage 1 = Getting it started
Stage 2 = Getting it right
Transition to Automation
Fiscal Year
2012 2013 2014 2015 2016 2017 2018 2019
Inpatient Quality Reporting Program(Pay for reporting)
MB – 2.0If Failure to Report
MB – 2.0If Failure to Report
MB – 2.0If Failure to Report
MB – ¼ of MB If
Failure to Report
MB – ¼ of MB If
Failure to Report
MB – ¼ of MB If
Failure to Report
MB – ¼ of MB If
Failure to Report
MB – ¼ of MB If
Failure to Report
Health Information Technology Meaningful Use (MU)
MB – ¼ of MB
If Failure to Meet
MU
MB – ½ of MB
If Failure to Meet
MU
MB – ¾ of MB
If Failure to Meet
MU
MB – ¾ of MB
If Failure to Meet
MU
MB – ¾ of MB
If Failure to Meet
MU
Problems with Stage 1
Improperly developed e-measure specifications
e-measure
Problems with Stage 1
Improperly developed e-measure specifications
No measure steward
e-measure
Problems with Stage 1
Improperly developed e-measure specifications
No measure steward
No testing
Lack of clinical information
Musts for Stage 2
IQR Automation
IQRAutomation
IQR Automation=
Musts for Stage 2
Hospital sends Data to Vendor
QIO Data
Warehouse
Feedback Reports
Data Submission
Hospital sends Data to Vendor
Vendor Validation
TJC Validation
Validation #1
CMS Requests
Cases
Hospital Sends
Records
CMS Re-Abstracts
Data
Validation #2
Proposed Quality Reporting Requirements for Stage 2 – Linked to National Quality Strategy
34 new measures
15 measures from Stage 1
1. Menu of 49 Measures available for Stage 2
2. Hospitals and CAHs choose 24 measures to report, to include one from
each of six domains
Efficiency(4)
Patient and Family
Engagement (8)
Clinical Processes
(24)
Care Coordina-
tion (2)
Patient Safety
(9)
Population/ Public
Health (2)
Quality Measure Domains
Care Coordination (2)
Stage 2 Proposed Measures for Care Coordination
NQF Number
Measure Title Use in other CMS Quality Programs
0441 Stroke – assessed for rehabilitation IQR
0496 ED – median time from ED arrival to ED departure for discharged ED patients
OQR, MAP
Quality Measure Domains
Population/ Public
Health (2)
Stage 2 Proposed Measures for Population and Public Health
NQF Number
Measure Title Use in other CMS Quality Programs
1653 Pneumococcal immunization IQR, MAP
1659 Influenza immunization IQR, MAP
Quality Measure Domains
Efficiency(4)
Stage 2 Proposed Measures for Efficient Use of Healthcare ResourcesNQF
NumberMeasure Title Use in other CMS
Quality Programs0148 Pneumonia (PN) – blood cultures
performed in the ED prior to initial antibiotic received in hospital
IQR, HVBP, MAP
0147 PN – initial antibiotic selection for community-acquired PN in immunocompetent patients
IQR, HVBP, MAP
0528 SCIP – prophylactic antibiotic selection for surgical patients
IQR, HVBP, MAP
0529 SCIP – prophylactic antibiotics discontinued within 24 hours after surgery end time
IQR, HVBP, MAP
Quality Measure Domains
Patient and Family
Engagement (8)
Stage 2 Proposed Measures for Patient and Family EngagementNQF
NumberMeasure Title Use in other CMS
Quality Programs
0495 Emergency Department (ED) Throughput – Median time from ED arrival to ED departure for admitted patients
IQR, Stage 1 MU
0497 ED Throughput – admit decision time to ED departure time for admitted patients
IQR, Stage 1 MU
0440 Stroke – education IQR, Stage 1 MU0375 Venous Thromboembolism (VTE) –
discharge instructionsIQR, Stage 1 MU
Quality Measure Domains
Patient and Family
Engagement (8)
Stage 2 Proposed Measures for Patient and Family Engagement
NQF Number
Measure Title Use in other CMS Quality Programs
0136 Heart Failure (HF) – discharge instructions
IQR, HVBP
0338 Home management plan of care document given to patient/caregiver
MAP
0341 Pediatric Intensive Care Unit (ICU) – pain assessment on admission
MAP
0342 Pediatric ICU – periodic pain assessment
MAP
Quality Measure Domains
Patient Safety(9)
Stage 2 Proposed Measures for Patient SafetyNQF
NumberMeasure Title Use in other CMS
Quality Programs0371 VTE – prophylaxis IQR, Stage 1 MU0372 VTE – ICU prophylaxis IQR, Stage 1 MU0375 VTE – incidence of potentially
preventable VTEIQR, Stage 1 MU
0527 Surgical Care Improvement Project (SCIP) – prophylactic antibiotic received one hour prior to surgical incision
IQR, HVBP, MAP
0301 SCIP – surgery patients with appropriate hair removal
IQR
Quality Measure Domains
Patient Safety(9)
Stage 2 Proposed Measures for Patient Safety
NQF Number
Measure Title Use in other CMS Quality Programs
0453 SCIP – urinary catheter removed on postoperative day one or postoperative day 2 with day of surgery being day zero
IQR, MAP
0434 Stroke – VTE prophylaxis IQR, MAP
0218 SCIP – surgery patients who received appropriate VTE prophylaxis with 24 hours prior to surgery to 24 hours after surgery end time
IQR, HVBP, MAP
0716 Healthy term newborn MAP
Quality Measure Domains
Clinical Processes (24)
Stage 2 Proposed Measures for Clinical Processes/EffectivenessNQF
NumberMeasure Title Use in other CMS
Quality Programs0435 Stroke – discharge on anti-thrombotic
therapy at hospital dischargeIQR, Stage 1 MU
0436 Stroke – anticoagulation therapy for atrial fibrillation/flutter
IQR, Stage 1 MU
0437 Stroke – thrombolytic therapy IQR, Stage 1 MU0438 Stroke – antithrombotic therapy by end
of hospital day twoIQR, Stage 1 MU
0439 Stroke – discharged on statin medication
IQR, Stage 1 MU
0373 VTE – patients with overlap of anticoagulation therapy
IQR, Stage 1 MU
Quality Measure Domains
Clinical Processes (24)
Stage 2 Proposed Measures for Clinical Processes/EffectivenessNQF
NumberMeasure Title Use in other CMS
Quality Programs0374 VTE – patients unfractionated heparin
dosages/platelet count monitoring by protocol receiving dosages/platelet count monitored by protocol
IQR, Stage 1 MU
0132 Acute Myocardial Infarction (AMI) – aspirin at arrival
IQR
0142 AMI – aspirin prescribed at discharge IQR, MAP0469 Elective delivery prior to 39 completed
weeks gestationMAP
0137 AMI – ACE/ARB for left ventricular systolic dysfunction
IQR
Quality Measure Domains
Clinical Processes (24)
Stage 2 Proposed Measures for Clinical Processes/EffectivenessNQF
NumberMeasure Title Use in other CMS
Quality Programs0160 AMI – beta blocker prescribed at
dischargeIQR
0164 AMI – fibrinolytic therapy received within 30 minutes of hospital arrival
IQR, HVBP, MAP
0163 AMI – primary percutaneous coronary intervention
IQR, HVBP, MAP
0639 AMI – statin prescribed at discharge IQR, MAP0300 SCIP – cardiac patients with controlled
6 AM postoperative serum glucoseIQR, HVBP, MAP
Quality Measure Domains
Clinical Processes (24)
Stage 2 Proposed Measures for Clinical Processes/EffectivenessNQF
NumberMeasure Title Use in other CMS
Quality Programs0284 SCIP – surgery patients on a beta
blocker therapy prior to admission who received a beta blocker during the perioperative period
IQR, HVBP, MAP
0480 Exclusive breastfeeding at hospital discharge
N/A
0481 First temperature measured within one hour of admission of the neonatal ICU
N/A
0482 First neonatal ICU temperature less than 36 degrees Celsius
N/A
0143 Use of relievers for inpatient asthma MAP0144 Use of systemic corticosteroids for
inpatient asthmaMAP
0484 Proportion of infants 22 to 29 weeks gestation treated with surfactant who are treated within 2 hours of birth
MAP
1354 Hearing screening prior to hospital discharge
MAP
Quality Measurement Domain Framework
Efficiency(4)
Patient and Family Engagement (8)
Clinical Processes (24)
Care Coordination (2)
Patient Safety(9)
Population/ Public Health (2)X
X
Measurement
CHOICE
Quality Measurement Domain Framework
Measure Submission
• Sampling of patients to populate quality measures
– Short-term
– Long-term
• Minimum case count
Proposed Quality Reporting Requirements for EPs for Stage 2CMS seeks comments on three options:
Option 1A – Report 12 measures from a menu set of 125 measures, with at least one measure in each of 6 domains
Option 1b – Report 11 “core” measures and choose 1 from the menu of 125 measures
Option 2 – Choose 3 quality measures to report under the Physician Quality Reporting System (PQRS) for EHRs
Option 1a – Linked to National Quality Strategy
83 new measures
42 measures from Stage 1
1. Menu of 125 Measures available for Stage 2
2. EPs must choose 12 measures to report, with at least one from each of
six domains
Efficiency
Patient and Family
Engagement
Clinical Processes
Care Coordina-
tion
Patient Safety
Population/ Public Health
Option 1b – 11 core measures plus 1 choice
Choose 1 from menu of 125 measures available for Stage 2
Report 11 “core” measures1. Closing the referral loop2. Functional status assessment for
complex chronic conditions3. Controlling high blood pressure4. Medication reconciliation5. Screening for clinical depressing6. Tobacco use screening and cessation7. Cholesterol screening8. Use of aspirin/antithrombotic for
Ischemic Vascular Disease9. Weight assessment and counseling of
children10. Use of high-risk medications in the
elderly11. Adverse drug event prevention
Certification Overview
Certification distorts the EHR market and raises costs.
Requiring health care providers to purchase certified products (or certify their self-developed systems) fundamentally changes the market dynamics in favor of the vendor.
Certification Round #1
CMS proposes 49 measures for hospitals and 125 measures for
EPs
Vendors must demonstrate a single CQM can be calculated
CMS requires one measure from six different quality domains
Certification Round #2
CMS proposes submission of patient-level or aggregate CQM
data
EHRs are not required to calculate CQMs in any specific format
Certification Round #3
QUALITYDATA
MODEL
Glass Half Full?
What Next?
HIT Efforts
MeasureApplicationPartnership
CQM Process Mapping
Measure previously specified
Measure Authoring Tool (MAT)
New Specification
Medical Record
Abstraction Spec
e-MeasureSpec
CQM Process Mapping
Measure Authoring Tool (MAT)
Measure previously specified
New Specification
Medical Record
Abstraction Spec
e-MeasureSpec
Quality Data Model(QDM)
Hospitals EHRVendors
CQM Process Mapping
Measure Authoring Tool (MAT)
Quality Data Model(QDM)
Hospitals EHRVendors
Where is the
measure developer?
X e-Measure Developer
IPPS Proposed Rule
MeasureApplicationPartnership
HACsXX X
Resources
• AHA Member Materials on Meaningful Use
http://www.aha.org/meaningfuluse• Office of Civil Rights – HIPAA resources
http://www.hhs.gov/ocr/privacy
• Office of the National Coordinator for HIT - Certification program
http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2
• Centers for Medicare and Medicaid Services – Medicare and Medicaid EHR Incentive Programs
http://www.cms.gov/EHRIncentivePrograms
Missouri Hospital Association
Meaningful Use Quality Measure Update