s2mu part ii: choosing wisely among menu requirements and clinical quality measures

REC support is. provided under cooperative agreement 90RC0025/01 from the Office of the National Coordinator for HIT, US Dept. of Health and Human Services


S2MU Part II: Choosing wisely among Menu Requirements and Clinical Quality Measures

Moderator:Mary Zile, BSN, MHSA

Speakers: Andrew Bledsoe, MBANathan Diller, MBA, MHSA


Agenda

• Overview of Meaningful Use

• Deep Dive: S2MU Menu Measures

• Deep Dive: Clinical Quality Measures

• Question & Answers

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Overview of Meaningful Use


Definition of Meaningful Use

• Use of ONC-HIT Certified Electronic Health Records (EHR)

• Electronic Exchange of Health Information

• Quality Reporting

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HITECH: Policy Framework

Better care for individuals, better health for populations, and lower per-capita costs. IHI-Triple Aim Initiative


Pillars of Meaningful UseImprove quality, safety, efficiency, and reduce health disparities

• Provide access to comprehensive patient health data for patient’s health care team • Use evidence-based order sets and CPOE• Apply clinical decision support at the point of care• Generate lists of patients who need care and use them to reach out to patients

Engage patients and families• Provide patients and families with timely access to data, knowledge, and tools to make

informed decisions and to manage their healthImprove care coordination

• Exchange meaningful clinical information among professional health care teamImprove population and public health

• Submit immunization, syndromic surveillance and reportable disease data to public health agencies

Ensure privacy and security protection for personal health information• Protect confidential information through operating policies, procedures, and technologies• Provide transparency of data sharing to patient


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Why S2MU Matters• Stage 2 Meaningful Use serves as a foundation for

other health care innovation initiatives

• S2MU is a glide path to:• Accountable care organizations• Medical home• Payment reform initiatives

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Stages of Meaningful Use

http://www.cms.gov/EHRIncentivePrograms

http://www.cms.gov/EHRIncentivePrograms


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For Medicare Hospitals:


Medicare Payment Adjustments

Medicare EPs who are not meaningful users will be subject

to a payment adjustment beginning on January 1, 2015.

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Medicare Payment Adjustments

EPs who first demonstrated meaningful use in 2011 or 2012 must demonstrate meaningful use

for a full year in 2013 to avoid payment adjustments in 2015. They must continue to

demonstrate meaningful use every year to avoid payment adjustments in subsequent years.

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Hardship Exceptions for Medicare EPs

EPs can apply for hardship exceptions in the following categories:• Infrastructure• New EPs• Unforeseen circumstances• By specialist/provider type

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Meaningful Use – Who is eligible for incentives? Eligible Providers in

MedicareEligible Providers in

MedicaidEligible Professionals (EPs) Eligible Professionals (EPs)

Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules)

Doctor of Dental Surgery or Dental Medicine

Nurse Practitioners (NPs)

Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs)Doctor of Optometry DentistsChiropractor Physician Assistants (PAs) who

practice in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA

Eligible Hospitals Eligible HospitalsAcute Care Hospitals Acute Care HospitalsCritical Access Hospitals (CAHs) Children’s Hospitals

No Changes from Stage 1 Meaningful

Use


S2MU Change in Total Objectives Required

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Stage 1 MU – Eligible Professionals Stage 2 MU – Eligible Providers15 core objectives 17 core objectives

5 of 10 menu objectives 3 of 6 menu objectives

20 total objectives 20 total objectives

Stage 1 MU – Eligible Hospitals & CAHs

Stage 2 MU – Eligible Hospitals & CAHs

14 core objectives 16 core objectives

5 of 10 menu objectives 3 of 6 menu objectives

19 total objectives 19 total objectives


How to Get to S2MU

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17 Core Objectives 3 of 6 Menu Objectives

9 Clinical Quality

Measures

Meaningful Use


Deep Dive: S2MU Menu Measures

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Stage 2 MU EP Menu ObjectivesMenu Objective Measure

1. Imaging Results More than 20% of imaging results are accessible through Certified EHR Technology

2. Family History Record family health history for more than 20% of unique patients

3. Syndromic Surveillance Successful ongoing transmission of syndromic surveillance data

4. Cancer Successful ongoing transmission of cancer case information

5. Specialized Registry

Successful ongoing transmission of data to a specialized registry

6. Progress Notes Enter an electronic progress note for more than 30% of unique patients


EP Menu Set Requirements

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Objective Stage 1 MU Stage 2 MU Summary of Change

Imaging results consisting of the image itself and

any explanation or other

accompanying information are

accessible through CEHRT

N/A

More than 10% of all tests whose result is one or

more images ordered by an EP during the EHR reporting period are accessible through

CEHRT.

New Requirement



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Record patient family health history as structured data

N/A

More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree

relatives.

New Requirement



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Record electronic notes in patient

records

N/A

Enter at least one electronic progress note

created, edited and signed by an EP for more than 30% of unique patients with at least one visit

during the EHR reporting period. Electronic progress

notes must be text-searchable.

New Requirement



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Capability to submit electronic syndromic

surveillance data to public health

agencies, except where prohibited, and in accordance with applicable law

and practice

N/A

Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a

public health agency for the entire EHR reporting

period.

New Requirement



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Capability to identify and report cancer cases to a

State cancer registry, except

where prohibited, and in accordance with applicable law

and practice

N/A

Successful ongoing submission of cancer case information from CEHRT to a public health central

cancer registry for the entire EHR reporting

period.

New Requirement



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Capability to identify and report specific cases to a specialized registry

(other than a cancer registry),

except where prohibited, and in accordance with

applicable law and practice

N/A

Successful ongoing submission of specific case information from

CEHRT to a specialized registry for the entire EHR

reporting period.

New Requirement


Deep Dive: Clinical Quality Measures

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Domains

Patient and Family Engagement

Patient Safety Care Coordination

Population/Public HealthEfficient Use of Healthcare Resources

Clinical Process/Effectiveness

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How do CQMs relate to the CMS Incentive Programs?

Although reporting CQMs is no longer a core objective of the EHR Incentive Programs, all providers are required to report on CQMs in order to demonstrate Meaningful Use.

In 2014 and beyond, reporting programs (i.e., PQRS, eRx reporting) will be streamlined in order to reduce provider burden.


Alignment Among Programs 2014 represents CMS’s commitment to aligning quality measurement and reporting among programs, including Hospital Inpatient Quality Reporting Program, PQRS, CHIPRA, and ACO Programs.

Hospital Inpatient Quality

Reporting Program

PQRS

CHIPRA

ACO


Reporting CQMs in 2014 and Beyond

Beginning in 2014, all Medicare-eligible providers in their second year and beyond of demonstrating meaningful use must electronically report their CQM data to CMS.

Medicaid providers will electronically report their CQM data to their state.


Clinical Quality Measures

Provider Prior to 2014 2014 and Beyond*

EPs

Complete 6 out of 44:

3 core or 3 alt. core +

3 menu

Complete 9 out of 64 Must cover at least 3 NQS domains

Recommended core CQMs include:

9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains

Eligible Hospitals and CAHs Complete 15 out of 15

Complete 16 out of 29 Choose at least 1 measure in 3 NQS domains


Please note:• In 2014, providers will only demonstrate Meaningful

Use for a three-month period • EP’s – Calendar Year• EH’s – Fiscal Year(Medicare Providers three month period must be tied to quarter)

• All subsequent reporting period will be entire year

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Reporting Options for EP’s – 2014 and AfterCategory Data Level Payer Level Submission

TypeReporting Schema

EP’s in First Year of MU Aggregate All Payer Attestation Submit 9 CQM’s covering 3 Domains

EP’s Beyond the First Year of Demonstrating Meaningful Use

Option 1 Aggregate All Payer Electronic Submit 9 CQM’s covering 3 Domains

Option 2 Patient Medicare Only Electronic Satisfy Requirements of PQRS using CEHRT

Group Reporting (Only EP’s Beyond the First Year of Demonstrating Meaningful Use)

EP’s in an ACO (Medicare Shared Savings Program or Pioneer ACO’s

Patient Medicare Only Electronic Satisfy Requirements of ACO

EP’s Satisfactorily Reporting via PQRS Group Reporting Options

Patient Medicare Only Electronic Satisfy Requirements of PQRS Group reporting using CEHRT

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Recommended Core CQM’sFor both adult and pediatric providers, CMS is

recommending certain core CQM’s for providers

These recommendations were based on the following:• Conditions contributing to morbidity and mortality• Conditions representing national public health priorities• Conditions common to health disparities• Conditions driving healthcare costs• Measures allowing agencies to more effectively measure quality care• Measures that include patient and/or caregiver engagement

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Recommended Core CQM’s

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Adult Recommended Core Measures

NQF: 018 Controlling High Blood Pressure

NQF: 022 Use of High-Risk Medications in the Elderly

NQF: 028 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention

NQF: 052 Use of Imaging Studies for Low Back Pain

NQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-Up

NQF: 419 Documentation of Current Medications in the Medical Record

NQF: 421 Preventative Care and Screen: Body Mass Index Screening and Follow-Up

NQF: TBD Closing the Referral Loop: Receipt of Specialist Report


Recommended Core CQM’s

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Pediatric Recommended Core Measures

NQF: 002 Appropriate Testing for Children and Pharyngitis

NQF: 024 Weight Assessment and Counseling for Nutrition and Physical Activity

NQF: 033 Chlamydia Screening for Women

NQF: 038 Childhood Immunization Status

NQF: 069 Appropriate Treatment for Children with Upper Respiratory Infection

NQF: 108 ADHD: Follow-Up Care for Children Prescribed ADHD Medication

NQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-Up

NQF: TBD Children Who Have Dental Decay or Cavities


CQM By SpecialtyThe CQM’s can be grouped by the following areas:• Asthma - 1• Cancer Screening and Oncology Measures – 7• Cardiovascular Care Measures – 11• Coordination of Care Measures – 1• Family Medicine Measures – 15• Dental Care Measures – 2• Diabetes Measures – 8• Measures for Elderly Patients – 4

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CQM By Specialty• Functional Status Measures – 3• Imaging Measures 2• Infectious Disease Measures – 7• Mental Health and Substance Abuse Measures – 13• Pediatric Measures – 9• Prenatal Measures – 2• Preventative Care Measures – 16• Vaccination Measures – 3• Vision Care Measures – 6• Women’s Health Measures – 5

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Reporting SpecificationsEach eCQM can be described in 3 different ways

depending on the intended use:HTML - This is a human readable format so that the

user can understand both how the elements are defined and the underlying logic used to calculate the measure.

XML – This is a computer readable format which enables the automated creation of queries against an EHR or other operational data store for quality reporting.

Value Sets – Value sets are the specific codes used by developers to program the system to accurately capture patient data in the EHR system.

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Q&A Session

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Additional MU Information

Tri-State Regional Extension Center

www.tristaterec.org/S2MU

CMS EHR Incentive Program Home Page

http://www.cms.gov/EHRIncentivePrograms/

Office of National Coordinator for Health IT http://healthit.gov/

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http://www.tristaterec.org/S2MU

http://www.cms.gov/EHRIncentivePrograms/

http://healthit.gov/


References / Resourceshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

http://www.healthit.gov/providers-professionals/how-attain-meaningful-use

http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecifications.zip

http://motorcycleguy.blogspot.com/2012/11/hashtag-soup-relating-qdm-hqmf.html

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html










References / Resourceshttp://

www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.html

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http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.html




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