Quality Measures for Meaningful Use and Beyond

Melissa Swanfeldt,Associate Vice President, MEDITECH

Zahid W. Butt, MD, FACG, CEO, Medisolv

• Stage 1 Clinical Quality Measures for Meaningful Use

• Quality Measure Trends Beyond MU

• What we know about Stage 2 CQMs

Stage 1 Clinical Quality Measures for Hospitals

15 e-Measures

• Stroke

• VTE

• ED Throughput

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

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

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

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)

All Measure Results in One Simple Screen

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Drilldown to Analyze Results

Page 9

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

THE QUALITY “ENTERPRISE”

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

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

Dual Environment Challenges

• Quality Measurement Governance• Data Collection Issues• Performance Rate Validation• Benchmarking Issues• Patient Level Data Submission Issues• Public Reporting Issues

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

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

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

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

MEDITECH Prepares for Stage 2 Quality Reports

• Specification Review

• Best Practice Workflows

• Focus Groups

• Nomenclature Mapping Tools

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

Current State Analysis