PowerPoint Presentation

Series 1: Meaningful Use for Behavioral Health Providers9/2013From the CIHS Video Series Ten Minutes at a Time

Module 5: Clinical Quality Measures and Behavioral Health

Welcome to the SAMHSA-HRSA Center for Integrated Health Solutions video series Ten Minutes at a Time. This comprehensive information system on how to select an electronic health record system and how to meet the standards for Meaningful Use is organized into brief, convenient modules targeted to behavioral health providers. This is Series 1 Meaningful Use for Behavioral Health Providers Module 5, Clinical Quality Measures and Behavioral Health. The goal of this module is to provide you with the information you need to understand and report on the Clinical Quality Measures, especially those related to Behavioral Health.1Module 7 Outline Core Objective #10 Report Ambulatory Clinical Quality Measures to CMSHow Clinical Quality Measures are Defined

How Clinical Quality Measures are Gathered and Reported

The Clinical Quality Measures for Behavioral Health

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures

Core Objective #10 evaluates the eligible professionals ability to electronically calculate and report on the three Core or the three Alternate Core Clinical Quality Measures and three Additional Clinical Quality Measures selected from a Menu. We will discuss who defines the Clinical Quality Measures, the Measure requirements, and we will review the Clinical Quality Measures for Behavioral Health

Click this link for more information: http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures 2Core Objective #10: Clinical Quality Measures (CQMs)

Objective 10Report ambulatory clinical quality measures to CMS

Measure For 2011, provide aggregate numerator, denominator, and exclusions through attestation. For 2012, electronically submit the clinical quality measures

Stage 1 focus ABILITY to report on CQMs

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures

The requirements and specifications around Clinical Quality Measures in Meaningful Use Stage 1 are identified in Core Objective #10. The EP is required to report on three Core CQMs. If one or more of these do not apply to their practice, they can select from any one of the three Alternate Core CQMs to fill the gap. They must also report on 3 Additional CQMs from a Menu set of CQMs. It is important to note that during Stage 1 the focus is on demonstrating the ABILITY to report on CQMs. If none of the Core and Additional CQMs apply to the EPs practice, it is acceptable to report 0 in the denominator. Lets begin by taking a look at the first three Core CQMs.

http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/clinical-quality-measures

3Three Core CQMsNQF 0013 Hypertension Blood Pressure MeasurementPercent of patient visits for patients 18+ with a diagnosis of hypertension who have been seen for at least 2 office visits with blood pressure recordedNQF 0028 Preventative Care and Screening Measure PairA) Tobacco assessment percent of patients 18+ who have been seen for at least 2 office visits who were queried about tobacco use one or more times within 24 monthsB) Tobacco cessation intervention percent of patients 18+ identified as tobacco users within the past 24 months who received cessation interventionNQF 0421 Adult Weight Screening and Follow Up Percent of patients 18+ with a calculated BMI in the past 6 months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow up plan is documented

Only the National Quality Forum or NQF can endorse CQMs for meeting the Meaningful Use standard. The NQF identified these three CQMs as Core CQMs. For NQF 0013 regarding hypertension, the provider must report on the percent of patients who are 18 or older, diagnosed with hypertension and have been seen for at least two office visits when blood pressure was recorded. NQF 0028 is actually a pair of measures the first concerns tobacco assessment, and the second concerns tobacco cessation and intervention. Note that the time frame is 24 months and the age group begins with age 18 or older. Contrast this with Core Objective #5, which requires the EP to record the smoking status of patients 13 years old and older during the reporting period of one year. NQF 0421 concerns adult weight screening and follow up for patients 18 years old or older. This can be contrasted with Core Objective #8 to Record Vital Signs (except blood pressure) for patients of all ages. Vital signs include BMI. Blood pressure is recorded only for those patients 3 years old and older. Any EP who either sees no patients 3 years old or older, or who believes that all three vital signs of height, weight, and blood pressure for their patients has no relevance to their scope of practice can be excluded from meeting this measure. However, they should review and report on any of the three Alternate Core Measures if they are more pertinent.

4Three Alternate CQMsNQF 0024 Weight Assessment and Counseling for Children and AdolescentsThe percentage of patients 2-17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year. NQF 0038 Childhood Immunization StatusPercentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and nine separate combination rates.NQF 0041 Preventive Care and Screening: Influenza Immunization for Patients > 50 Years Old Percent of patients 50 years and older who received an influenza immunization during the flu season (September February)

The three alternate Core CQMs concern weight assessment and counseling for children and adolescents, childhood immunization status, and preventive care and screening for older adults. So if, for example, the EP does not have any patients in their practice who are 18 years old or older, they may be able to select NQF 0024 and 0038 from the Alternate Measure set to meet the required three Core CQMs.5Attesting/Reporting on Core/Alternate Core CQMsRequired to report but you can report a 0 denominatorCore CQMsEPs must report on 3 Required Core CQMs. But if the denominator of 1 or more of the required Core CQMs is 0, then EPs are required to report results for up to three Alternate Core CQMsIf any or all of the Core CQMs dont apply to the EPs scope of practice, the EHRS must still be able to calculate all three Core CQMs and demonstrate that the denominator is 0Alternate Core CQMsIf Alternate Core CQMs dont apply and the EP cant report a number in order to meet the required three Core/Alternate Core CQMs, then the EPs are required to report the measures with a 0 denominator for all three Alternate Core CQMsWould mean reporting on a total of 6 Core/Alternate Core CQMs

EPs must report on a total of three Core CQMs, using the Alternate Core CQMs if necessary. You may be wondering what to do if none of the Core or Alternate Core CQMs apply in the EPs situation. In this case, the CQMs would still be reported, but the denominators would be zero.

So for example, it may be that the EP does not have any patients 18 years old or older with hypertension. For that particular measure, they would report it but the denominator would be zero. They would then look to the Alternate set of CQMs for a measure that could be used to meet the requirement to report out on three Core CQMs. If none of the Alternate Core CQMs are applicable to their practice, they would report those three Alternate measures with a zero in the denominator. It is conceivable that the EP might report out on six Core CQMs, with all six having the denominator of zero.6Three Additional CQMs Must Be SelectedSelect 3 from a list of 44 Additional CQMs

Complete EHRS Certification (Ambulatory Outpatient) requires ability to report on 6 Core/Alternate Core CQMs and at least 3 Additional CQMs that are specific to the scope of practice they serve

If you do not have data for one or more of the three Additional CQMs, you must report 0 in the denominator for those Additional CQMs

If the EHR does not calculate CQMs that the provider wants to report on, the provider is not required to report on those CQMs, and may select any CQM and report 0 in the denomonator. http://oncchpl.force.com/ehrcert/CHPLHome

As with the Menu Objectives for Meaningful Use, there is a set of Menu or Additional CQMs. For Stage 1 there is a total of 44 Additional CQMs. The eligible professional selects three of these for reporting. This set of CQMs should not be confused with the Alternate set of Core CQMs. The three Additional CQMs are reported in addition to the Core CQMs, even if the denominator for the Core CQMs is zero. When an EHR is certified it must be able to generate these reports. If it is not possible to populate the denominator for three Additional CQMs, the provider would once again report on these measures, selecting 0 for the denominator.

For Stage 1, providers can use any of the 44 CQMs approved for Meaningful Use, but three are specific to Behavioral Health. Lets look at these more closely.

http://oncchpl.force.com/ehrcert/CHPLHome

7Behavioral Health, Menu Set, CQM NQF 0004NQF 0004 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (a) Initiation, (b) EngagementPercent of adolescent and adult patients with a new episode of alcohol and other drug (AOD) dependence who initiate treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization within 14 days of the diagnosis and who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

http://bit.ly/18zF1up (APA explication of NQF 0004)

NQF 0004 concerns the initiation and engagement of Alcohol and Other Drug Treatment patients. This CQM seeks to ensure that once the problem is identified through intervention, treatment is initiated in a timely way. The APA offers a detailed discussion of this behavioral health-oriented clinical quality measure. Click this link for the APA discussion of this CQM: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&ved=0CD8QFjAE&url=http://www.psychiatry.org/File%2520Library/Practice/Managing%2520a%2520Practice/EHR%2520Scenario/NQR%2520Documents/NQF0004.pdf&ei=nh86UuroDsnl4AO_v4GoBQ&usg=AFQjCNGE5fDRj2Ww6RbUCns_pyAaK1kWBg&bvm=bv.52434380,d.dmg 8Behavioral Health, Menu Set, CQM NQF 0105NQF 0105 Anti-depressant medication management: (a) Effective Acute Phase Treatment, (b) Effective Continuation Phase TreatmentThe percent of male and female patients 18 years of age and older who were diagnosed with a new episode of major depression, treated with antidepressant medication, and who remained on an antidepressant medication treatment.

http://bit.ly/1570Pr3 (APA explication of NQF 0105)

NQF 0105 concerns anti-depressant medication management. This CQM can play an important role in the integration of primary and behavioral healthcare. Evidence indicates that depressive disorders are strongly related to the occurrence of many chronic diseases, and that aligning treatment for depression with methods used for managing other chronic illnesses is an important aspect of treatment for this particular mental health disorder. This means that psychiatric medication prescriptions should be carefully coordinated with other medications used for treating chronic illness, and that medication compliance plays a critical role in patient care. Click on the link provided for a detailed discussion of this CQM from the American Psychiatric Association.

Click this link for the APA discussion of this CQM: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CC4QFjAB&url=http%3A%2F%2Fwww.psychiatry.org%2FFile%2520Library%2FPractice%2FManaging%2520a%2520Practice%2FPQRS%2520Measures%2F9.pdf&ei=VCU6UuLhEtal4APilIDACA&usg=AFQjCNGlPEjEWV5_HljL-Z1wptIYedawrw&bvm=bv.52434380,d.dmg 9Behavioral Health, Menu Set, CQM NQF 0027NQF-0027 Smoking and Tobacco Use Cessation, Medical assistance: a) Advising Smokers and Tobacco Users to Quit, b) Discussing Smoking and Tobacco Use Cessation Medications, c) Discussing Smoking and Tobacco Use Cessation Strategies

Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies

http://bit.ly/18bZiSO (APA explication of NQF 0027)

You can contrast this CQM, NQF-0027 from the Additional set of clinical quality measures with NQF 0028 from the Core CQM set. This measure speaks directly to medical assistance in tobacco intervention and/or cessation.

Click this link for an explication of NQF-0027 from the APA: http://www.psychiatry.org/File%20Library/Practice/Managing%20a%20Practice/EHR%20Scenario/NQR%20Documents/NQF0027.pdf 10Guidance on Core and Alternate Core Clinical Quality Measures, Additional MeasuresGuidance from CMS on all of the Stage 1 NQF Clinical Quality Measures can be found here: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_EPs_2012_02_02.pdf

Guidance from American Psychiatric Association on Meaningful Use and Clinical Quality Measures http://www.psychiatry.org/practice/managing-a-practice/electronic-health-records/medicare-and-medicaid-electronic-health-record-ehr-incentive-payment-programs

For an overview of all of the clinical quality measures, please use this link from the Center for Medicaid/Medicare Services. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM_EPs_2012_02_02.pdf

For a discussion of Meaningful Use, the Eligible Professional Incentive Program and the Clinical Quality Measures including the Additional CQMs for Behavioral Health, please use the link provided to visit the site for the American Psychiatric Association. http://www.psychiatry.org/practice/managing-a-practice/electronic-health-records/medicare-and-medicaid-electronic-health-record-ehr-incentive-payment-programs 11Summary of Key PointsThe CQM reporting requirement tests the ability to report on Core/Alternate Core and Additional CQMs it does not require actual numbers of patients if these are not available.

Reports on CQMs can have 0 as the denominator

The Certified Complete EHR captures data on all six Core/Alternate Core CQMs and at least three Menu CQMs relevant to the scope of practice they serve.

So here are some things to remember. Clinical Quality Measure reporting requirements test the ability to report on Core or Alternate Core and also on Additional CQMs it does not require actual numbers of patients if these are not available. Reports on the core CQMs can have 0 as the denominator and if the EP is not able to report out on three Additional CQMs, it is acceptable to report 0 in the denominator for these as well. It is more important in Stage 1 to demonstrate that the ability is present in the EHR.

The Certified Complete EHR captures data on all six Core/Alternate Core CQMs and at least three Additional CQMs relevant to the scope of practice they serve. 12We Have Solutions for Integrating Primary and Behavioral Healthcare

Contact CIHS for all types of primary and behavioral health care integration technical assistance and training needs

1701 K Street NW, Ste 400 Washington DC 20006

Web: www.integration.samhsa.govEmail:integration@thenationalcouncil.orgPhone:202-684-7457

Prepared and presented by Colleen ODonnell, MSW, PMP, CHTS-IM for the Center for Integrated Health Solutions

Our thanks go to SAMHSA and to HRSA for providing support to the Center for Integrated Health Solutions (CIHS) for this and many other forms of training and technical assistance related to the integration of primary and behavioral health care. Please visit our web site at www.integration.samhsa.gov, email us at integration@thenationalcouncil.org, or just pick up the phone and give us a call at 202-684-7457.

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