quality measures for meaningful use and beyond melissa swanfeldt, associate vice president, meditech...
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Quality Measures for Meaningful Use and Beyond
Melissa Swanfeldt,Associate Vice President, MEDITECH
Zahid W. Butt, MD, FACG, CEO, Medisolv
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• Stage 1 Clinical Quality Measures for Meaningful Use
• Quality Measure Trends Beyond MU
• What we know about Stage 2 CQMs
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Stage 1 Clinical Quality Measures for Hospitals
15 e-Measures
• Stroke
• VTE
• ED Throughput
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Challenges
• Value sets use vocabularies not used widely in EHRs (SNOMED CT, RxNorm)
• e-Measure specifications contain multiple errors and inconsistencies
• HITSP Specification TN906 has over 500 data elements in the 15 measures
• Data capture must be in discrete fields
• Impact on workflow for clinicians
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Best Practice Guidance for Data Capture
• Nomenclature Mapping
• LOINC
• SNOMED CT and ICD-9 for problems
• RxNorm
• Exclusions
• Contraindications
• Clinical trials
ARRA Quality Reporting Page
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Stage 1 CQM’s for Eligible Professionals
44 Ambulatory Clinical Quality Measures
• 3 Core/3 Alternate Core
• 3 Additional Measures
• Use of MPM Clinical Reporting Tool for Stage 1
• Performance and Outcomes are not measured
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Stage I MU Quality Reporting
Prepare or Procrastinate
• Clinician Education is Essential• Sustainable Workflow Design/Redesign
– Minimize Data Capture Burden– Leverage Clinical Decision Support - CPOE
• “Problem Lists” Reconciliation• Performance Rate Analysis
(Errors vs. Low Performance)
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All Measure Results in One Simple Screen
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Drilldown to Analyze Results
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Review Non-Compliant Cases
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Why have 50+ Hospitals Chosen Medisolv for Meaningful Use Reporting?
“Medisolv team was outstanding. They offered clinical as well as programming resources. They are VERY knowledgeable about the measure requirements, clinical processes as well as reporting details. We began building for the quality measures in May and our 90 day period began June 1. The Medisolv team was very engaged and responsive. …we would likely not be attesting for stage I this year without their help.” From the MUSE List Server
Pamela Feeler, Director of Nursing Informatics - Phelps County Regional Medical Center
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• Quality Reporting is Central to Healthcare– CMS Programs: IQR,OQR,PQRS,VBP– Accreditation (The Joint Commission)– ARRA Meaningful Use– ACA & National Quality Strategy– NHSN & State Initiative
• Performance Matters– Pay for Performance – Public Perception/Reporting
Quality Measurement Trends
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THE QUALITY “ENTERPRISE”
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Quality e-Measures
• E-Measures Replace Abstracted/Paper Measures • “Dual Measures Environment” Will Persist for Many
Years• Patient Level Data Submission • Certification will Include Algorithm Validation • New Auditing Methods and Criteria
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Reliability of Hospital-Reported Quality Measure DataWe will review hospitals’ controls for ensuring the accuracy and validity of data related to quality of care that they submit to CMS for Medicare reimbursement. Hospitals must report quality measures for a set of 10 indicators established by the Secretary as of November 1, 2003. (The Social Security Act, § 1886(b)(3)(B)(vii).)A reduction in payments of 0.4 percent to hospitals that did not report quality measures to CMS was established by the MMA, § 501(b). The reduction was increased to 2 percent effective at the beginning of FY 2007. (Social Security Act, § 1886(b)(3)(viii), as added by the Deficit Reduction Act of 2005 (DRA), § 5001(a).) We note that the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) also expands the existing quality initiative. (OAS;W-00-11-35438; various reviews; expected issue date: FY 2012; new start; Affordable Care Act)
OIG 2012 Work Plan Priorities
http://oig.hhs.gov/reports-and-publications/archives/workplan/2012/Work-Plan-2012.pdf
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Dual Environment Challenges
• Quality Measurement Governance• Data Collection Issues• Performance Rate Validation• Benchmarking Issues• Patient Level Data Submission Issues• Public Reporting Issues
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Clinician Education
AQA-AQA HIT-Healthcare Information Technology CME-Continued medical evaluation HQA-Hospital Quality Alliance CPG-Clinical practice guidelines NCQA/JC-National Committee on Quality CPPD-Continued physician professional Assurance/Joint Commission development QASC-Quality Alliance Steering Committee
Measure Endorsement NQF
Measure Implementation AQA, HQA, QASC
Physician & Hospitals, etc.Health Plans and CMS
HIT vendors
Evidence and CPG Generation
HIT SupportCME/CPPDEvaluation
Measure DevelopmentPCPI & Specialty Assoc.
NCQA/JCCMS
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VTE 1 Workflow Summary
Physician Admission Order
Contraindication
Physician Order
Mechanical Prophylaxis
Pharmacologic Prophylaxis
VTE Prophylaxis
Nursing Documentation
EMAR/BMV
RXNORMSNOMED
SNOMED
Clinical Trial / Comfort
Measures
SNOMED
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The Tale of Two Problem Lists
• Problem List in Patient Summary Panel (Clinical Review)– ICD 9 or SNOMED linked to Mnemonic– Current vs. Historical– Attribute Selection
• Active vs. Resolved• Ordinality (Reason For Admission always first)
• Coded Visit Abstract– ICD 9 with Mapping to SNOMED
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New Workflow Paradigms
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Stage 2 Clinical Quality Measures
• 113 NQF Endorsed Measures
• 39 Eligible Hospital Measures
• 83 Eligible Professional Measures
• Practice
• Radiology
• Oncology
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MEDITECH Prepares for Stage 2 Quality Reports
• Specification Review
• Best Practice Workflows
• Focus Groups
• Nomenclature Mapping Tools
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Medisolv Quality Expertise
– The Joint Commission• ORYX® vendor for reporting Core Measures• 1 of only 14 ORYX Vendors Piloting e-Measures
– CMS • Q-Net vendor for Quality reporting
– Fully Engaged in the Quality Enterprise • Voting Member of the National Quality Forum• Chair HIMSS NQF Taskforce (Patient Safety
and Quality Committee)• Member CMS Meaningful Use CQM Technical
Expert Panel
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Current State Analysis
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