Stage 3 Update

Paul Tang, ChairGeorge Hripcsak, Co-Chair

Meaningful Use Workgroup

August 29, 2013

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Agenda

• Review what we heard last month• Re-confirm our focus on outcomes• Outline the outcomes-oriented framework• Connect the dots• Seek approval of outcomes-oriented

framework to flesh out details

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What We Heard

• Stage 3 focuses on outcomes; how do the functional objective recommendations link to outcomes?

• How does MU3 link to HHS initiatives (e.g. NQS, Million Hearts) and future payment models (e.g., ACO, MSSP, PCMH)?

• Deeming pathway is a good direction– Emphasizes outcomes– Reduces burden– Aligns with other federal programs– BUT, need appropriate QMs

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Updated Recommendations Based Upon Feedback from HITPC

1. Focus on improving care outcomes 2. Use of quality measures to assess identified

outcomes3. Incorporate functional deeming as an option

for stage 3 compliance4. Align with CMS and future payment priorities

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2009 - National Priorities Partnership

Improve the Safety and Reliability of America's Healthcare

Engage Patients and Families

Well-Coordinated Care Across All Providers, Settings, and Levels of

Care

Improve the Health of the Population

Appropriate and Compassionate Care for Patients With Life-

Limiting Illnesses

Eliminate Waste While Ensuring the Delivery of Appropriate Care

2011 - National Quality Strategy

Making care safer

Ensuring that each person and family are engaged as partners

Promoting effective communication and coordination

of care

Promoting effective prevention and treatment practices

Working with communities to promote healthy living

Making quality care more affordable

Meaningful Use

Improving quality, safety, and reducing health disparities

Engaging patients and families in their care

Improving care coordination

Improving population and public health

Privacy and Security

Harmonizing Meaningful Use and National Quality Strategy: National Priorities Partnership – Common Roots

National Quality Strategy: Serves as a catalyst and compass for a nationwide focus on quality improvement efforts and a national approach to measuring quality. The NQS concurrently pursues three aims to provide better, more affordable care for the individual and the community. To advance these aims, the NQS focuses on six priorities for health and health care quality that have an impact on most Americans.National Priorities Partnership: Convened by NQF, is composed of 28 organizations and is focused on a core list of priorities that will yield change in the form of improved care, equity, safety, and efficiency. NPP provides input on goals, measure concepts and strategic opportunities to achieve the NQS aims. Initially published in March 2011. 5

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Importance of an Outcomes-Based Framework

• Placeholder for Scenario

Recommendation 1: Focus on improving care outcomes

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Revised Care Outcomes Aligned with NQS

2011 - National Quality Strategy Priorities

Making care safer

Ensuring that each person and family are engaged as partners

Promoting effective communication and coordination

of care

Promoting effective prevention and treatment practices

Working with communities to promote healthy living

Making quality care more affordable

Revised MU3 Priority Outcomes

Improving quality of care and safety

Engaging patients and families in their care

Improving care coordination

Healthier living and disease prevention

Improving population and public health

Affordable Care

Equitable Care for All

Improving Quality of Care and Safety:Linking Outcomes with Stage 3 Functions

Stage 1 + 2

• Structured data– Problem, Meds, Allergy

lists– Vitals, smoking status– Lab results, Hospital

labs– Imaging

• CPOE• CDS• Progress notes• Safety

– eRx, drug-allergy checks

– Medication reconciliation

• Population management– Patient lists– Patient reminders

Stage 3

• CDS++• Order tracking (e.g.,

closing the loop)• Real-time dynamic

dashboards (for clinical and population health management)

• Medication adherence• Patient safety

– Common Format for registry reports (e.g. healthcare associated infections)

– Sharing radiation dosing information

– Capture FDA Unique Device Identifier (UDI)

Outcome Goals

• Quality of care– Better control of chronic diseases– Improved efficiencies to prevent

inappropriate care (overuse, underuse, and misuse)

– Reduce preventable hospital admissions and readmissions

• Improved population management

• Patient safety– Reduced incidence of adverse

events

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• Clinical summary• Online access• Patient education• View, download,

transmit• Secure messaging

Engaging patients and families in their care:Linking Outcomes with Stage 3 Functions

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Stage 1 + 2 Stage 3

• Patient education, clinical summary, & reminders provided to patients in their preferred means of communication

• Patient generated health data

• Communication preferences

• Amendments

Outcome Goals

• Improved access/sharing of information for the patient and caregiver

• Patients and caregivers recognized as partners– Shared decision-

making, care planning/goals

• Improved patient and caregiver experience

Improving care coordination:Linking Outcomes with Stage 3 Functions

• CDS+• Cancer registry• Family history• Electronic lab

reporting

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Stage 1 + 2

• Summary of care

Stage 3

• Health event notification (e.g., ED visit, admission to hospital)

• Close the referral loop

Outcome Goals

• Improved communication across care settings

• Improved coordination of care across the continuum

• Improved accountability across settings and reduction in health disparities

Disease Prevention: Linking Outcomes with Stage 3 Functions

• CDS+• Cancer registry• Family history• Electronic lab

reporting

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Stage 1 + 2

• CDS• Immunization• Patient education• PH reporting• Cancer registry• Family history• Electronic lab

reporting

Stage 3

• CDS+ interventions to manage chronic conditions

Outcome Goals

• Increased adherence with preventive health recommendations

Improving Population and Public Health: Linking Outcomes with Stage 3 Functions

• CDS+• Cancer registry• Family history• Electronic lab

reporting

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Stage 1 + 2

• Immunization• PH reporting• Cancer registry• Electronic lab

reporting• Submission of

electronic syndromic surveillance data

Stage 3

• Common Format for registry reports (e.g. healthcare associated infections)

• Case reports submitted to the state/local jurisdiction

Outcome Goals

• Improved population health

Affordable CareLinking Outcomes with Stage 3 Functions

• CDS+• Cancer registry• Family history• Electronic lab

reporting

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Stage 1 + 2

• Formulary checks• Generics

Stage 3

• Imaging results

Outcome Goals

• Improved efficiencies to prevent inappropriate care (overuse, underuse, and misuse)

• Race• Ethnicity• Language

Equitable Care for AllLinking Outcomes with Stage 3 Functions

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Stage 1 + 2 Stage 3

• Occupation• Sexual orientation

and gender identity• Veteran status• Patient education in

a language other than English

Outcome Goals

• Equitable care for all by reducing health disparities

Recommendation 2: Use of quality measures to assess identified outcomes

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Recommendation 2: Use of quality measuresto assess identified outcomes (I)

Improving quality of care and safety

• CV Risks• Blood pressure

control• LDL control• Falls• Pressure ulcer• HAI• Morphine

equivalent• “Never Give

Together”• Time in

therapeutic range for Warfrin

Increased Patient Engagement

• Knee• Hip• Heart Failure

(functional status)

Improved Care Coordination

• Close the referral loop

• Reciprocal referrals• Care transitions for

hospitals• Readmissions

Care Outcomes

Proposed CQMs

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Recommendation 2: Use of quality measuresto assess identified outcomes (II)

Healthier living and disease prevention

• Immunization (i.e., flu, pneumonia, childhood vaccinations)

• Cancer screening (i.e., colon, prostate, cervical)

Improving population and

public health

• HIV medical visit frequency

• Immunizations by 13

Affordable Care

• Choosing Wisely• Do not overtreat

A1C• Reduce CT scans

for headache• ED throughput• MRI back pain• Radiation dosing• Adherence

(reference CBO)

Equitable Care

Care Outcomes

Proposed CQMs

Recommendation 3: Incorporate functional deeming as an option for stage 3 compliance

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Recommendations on Functional Deeming

• Providers who have already met all functional objectives in stages 1 and 2 should be allowed to “deem”

• Deeming allows high MU performers (or significant improvers) to attest for MU by satisfying a subset of MU objectives; this would be an optional pathway to achieve MU

• “Deeming” promotes innovation, reduces burden, and rewards good performance

• CMS should survey the landscape for available eCQMs that are outcomes-oriented and consider their use as deeming measures; in addition, new development of eCQMs may be necessary

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Accountable Care Clinical Quality Measures Subgroup Tasks

1. Develop recommendations for ‘HIT-sensitive’ eCQM concepts and specific measures that could be used to deem” EPs and EHs as meaningful users through their ability to perform on quality outcomes

2. HIT-sensitive outcome measures are ideal for deeming– Which measures that currently exist in CMS programs are appropriate to

use for deeming? (charge to QM WG)– Which measures in the pipeline for MU3 time frame are appropriate to use

for deeming? What measure gaps exist, that could be filled in time for MU3, that are exemplars of HIT sensitive measures for deeming?

3. Eligible professionals and group reporting – What parameters should be used for a group reporting option for MU overall

(including deeming)– If there is a group reporting option, how do you attribute a provider's

membership in a group and his/her ability to receive incentives (or avoid penalties)?

Recommendation 4: Align with CMS and future payment priorities

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Alignment Across National Initiatives

NQF # NQF Measure Title MU- EPs SSP - ACOs PQRS

0018 Controlling High Blood Pressure 1 1 1

0028 Measure Pair: a. Tobacco Use Assessment, b. Tobacco Cessation Intervention

1 1 1

0068 Ischemic Vascular Disease (IVD): Use of Aspirin or another Antithrombotic

1 1 1

0075 IVD: Complete Lipid Profile and LDL Control < 100

1 1 1

0031 Breast Cancer Screening 1 1 1

0034 Colorectal Cancer Screening 1 1 1

0041 Influenza Vaccination 1 1 1

0043 Pneumonia vaccination status for older adults 1 1 1

0074 Chronic Stable Coronary Artery Disease: Lipid Control

1 1 1

0421 Adult Weight Screening and Follow-Up 1 1 1

Questions?