Aligning Meaningful Use CQM and PQRS Reporting for 2015

Transcription

1 Aligning Meaningful Use CQM and PQRS Reporting for 2015 August 19, 2015

2 Introductions Marni Anderson Project Specialist, MetaStar Laura Sawyer Clinical Application Coordinator, MPRO Ben West CTO, Health efilings Candy Hanson Program Manager, Stratis Health

3 Agenda Review reporting requirements for EHR Incentive Program CQMs and PQRS Review payment adjustments and potential incentives Deep dive into how to report quality measures once for both programs directly from your certified EHR Participating with Lake Superior Quality Innovation Network (LSQIN) Q & A 3

4 Lake Superior Quality Innovation Network Three quality improvement organizations: Stratis Health in Minnesota MPRO in Michigan MetaStar in Wisconsin Collaboration to improve health care for Medicare beneficiaries, share best practices and maximize efficiencies 4

5 Quality Improvement Initiatives During the next five years, Lake Superior QIN will focus on health care quality improvement initiatives that include: Improving cardiac health and reducing cardiac health care disparities Reducing disparities in diabetes care Improving prevention coordination through health information technology Reducing health care associated infections in hospitals Reducing health care acquired conditions in nursing homes Improving the coordination of care between health care settings Improving quality through performance-based incentives and reporting systems 5

6 Review of EHR Incentive Program CQM Requirements Eligible professionals Doctors of medicine or osteopathy Doctors of dental surgery or dental medicine Doctors of podiatry Doctors of optometry Chiropractors Certified EHR Technology (CEHRT) Electronic CQMs Technical specifications for EHR reporting CMS guidance Recommended adult and pediatric core set 6

7 Review of PQRS Reporting Requirements Eligible professionals Medicare physicians, practitioners and therapists billing MPFS Part B or CAH Method II Reporting methods Claims Registry QCDR Direct EHR Data Submission Vendor PQRS data analyzed by CMS and contributes to value based modifier 7

8 Why Electronic Reporting? 2015 is the performance year for 2017 payment adjustments EHR Incentive program PQRS and VBM 2017 is the first performance year for Merit- Based Incentive Payment System (MIPS) Incentives based on performance in EHR Incentive Program and PQRS/VBM Electronic reporting is easier and counts for multiple programs 8

9 2017 Payment Adjustments 9

10 How to Report Once To reduce the burden, the Centers for Medicare & Medicaid Services (CMS) has aligned reporting requirements for those reporting electronically using their certified electronic health record technology (CEHRT) The electronic clinical quality measures (ecqms) specifications are used for electronic reporting option for PQRS as well as the Medicare EHR Incentive Program Satisfactory reporting of ecqms for PQRS will allow group practices to qualify for the clinical quality measures (CQM) component of meaningful use 10

11 How to Report Once: Individual Report 9 measures across 3 domains covering a full year of data Submit this data in one of 3 ways: Direct EHR Data Submission Vendor Qualified Clinical Data Registry 11

12 How to Report Once: Group Using a Data Submission Vendor or EHR: Submit a full year of data with 9 measures OR submit a full year of data with 6 measures, plus CAHPS Using web interface (25+ EP s only): Submit a full year of data with all web interface measures 100+ EP groups are required to additionally do CAHPS 12

13 How to Report Once: ACO Both Pioneer and MSSP ACO s are required to use the web interface with a full year of data 13

14 Intro to Ben and Health efilings Health efilings is a Data Submission Vendor that works with any EHR. 100% of their customers files were accepted by Medicare last year. Their CTO Ben West is on the HL7 workgroup which created the QRDA standard, and advises Medicare and ONC on quality reporting standards 14

15 Electronic Reporting Workflow (not using a DSV) 1. Create an EIDM account 2. Work with your EHR vendor to extract QRDA files 1. Track and resolve any errors in your EHR 2. Track and ensure that files are created for every provider + TIN 3. Login to QualityNet and upload your files from #2 4. Resolve any errors 5. Repeat 2-4 until all providers are submitted 15

16 Electronic Reporting Workflow (using a DSV) 1. Create an EIDM account 2. Work with your EHR vendor to extract QRDA files 1. Track and resolve any errors in your EHR 2. Track and ensure that files are created for every provider + TIN 3. Login to QualityNet and upload your files from #2 4. Resolve any errors 5. Repeat 2-4 until all providers are submitted 1. Sign contract with a DSV 2. (some DSVs may make you do step number 2 above) 16

17 Getting Started Decide if you want to use a Data Submission Vendor Determine available measures Review ecqms available in your CEHRT Work with your CEHRT vendor to understand how to properly document patient care Understand how an ecqm is different/similar to measures used in registry or claims reporting 17

18 Example ecqm: Controlling High Blood Pressure Domain: Clinical Process/ Effectiveness Measure Description: Percentage of patients years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period. CMS165v3 - NQF# PQRS # GPRO HTN-2 18

19 Technical Details Quality Reporting Data Architecture (QRDA) Category I and III History of development and how they are created PQRS portal 19

20 Common Error Messages SHALL contain exactly one [1..1] effectivetime (CONF:26933). Meaning: a time is missing This id SHALL contain exactly one which SHALL be selected from ValueSet CMS Program Name STATIC (CONF:711162). Meaning: program is incorrect (e.g. you didn t declare that it was for PQRS) Even if you don t get an error message, that doesn t mean the submission was valid! If you don t use a DSV, you will need to work with your EHR vendor to resolve these 20

21 Example feedback report 21

22 Data Submission Vendor EIDM account not required Testing and error checking files submissions Who is a data submission vendor? EHR vendor (e.g. Epic) Dedicated DSV (e.g. Health efilings) 22

23 Things to ask a DSV/EHR Are you on the HL7 Clinical Quality Informatics workgroup? This workgroup manages the standards, so entities on that group will be more familiar with them Do you participate in the CMS quality reporting kaizens? Medicare invites leaders in quality reporting to advise them on their quality programs. Participation indicates that the DSV is thought highly of and participates in making policy. 23

24 Resources CMS links 24

25 Webinar slides will be posted at: Upcoming Events: Visit our listing at Follow Lake Superior QIN on social 25

26 How do I Sign Up? If you are interested in signing up or to learn more about the initiatives, please contact: Michigan: Laura Sawyer [email protected] Minnesota: Candy Hanson [email protected] Wisconsin: Marni Anderson [email protected]

27 Questions? Marni Anderson Project Specialist, MetaStar Laura Sawyer Clinical Application Coordinator, MPRO Ben West CTO, Health efilings Candy Hanson Program Manager, Stratis Health

28 Thank You! We look forward to partnering with you! Follow us The Lake Superior Quality Innovation Network represents the states of Michigan, Minnesota and Wisconsin. This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services 28(CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI/MN/WI-D