2014 Clinical Quality Measures Tipsheet Last Updated: August, 2012

Transcription

1 2014 Clinical Quality Measures Tipsheet Last Updated: August, 2012 Criteria fr Reprting Clinical Quality Measures 1. Medicare EHR Incentive Prgram Beginning in 2014, the reprting f clinical quality measures (CQMs) will change fr all prviders. EHR technlgy that has been certified t the 2014 standards and capabilities will cntain new CQM criteria, and eligible prfessinals (EPs), eligible hspitals, and critical access hspitals (CAHs) will reprt using the new 2014 criteria regardless f whether they are participating in Stage 1 r Stage 2 f the Medicare and Medicaid Electrnic Health Recrd (EHR) Incentive Prgrams. Althugh clinical quality measure (CQM) reprting has been remved as a cre bjective fr bth EPs and eligible hspitals and CAHs, all prviders are required t reprt n CQMs in rder t demnstrate meaningful use Prfessinals (EPs), will cntinue t reprt frm the 44 measures finalized fr Stage 1 in the same schema laid ut fr Stage 1 3 cre/alternate cre 3 additinal measures fr EPs hspitals and CAHs will cntinue t reprt the 15 measures finalized fr Stage 1 Beginning in 2012 and cntinuing in 2013, there are tw reprting methds available fr reprting the Stage 1 measures: ereprting Pilts: Attestatin ( Physician Quality Reprting System EHR Incentive Prgram Pilt fr EPs ereprting Pilt fr eligible hspitals and CAHs 2014 and Beynd EPs must reprt n 9 f the 64 apprved CQMs Recmmended cre CQMs encuraged but nt required 9 CQMs fr the adult ppulatin 9 CQMs fr the pediatric ppulatin NQF 0018 strngly encuraged since cntrlling bld pressure is high pririty gal in many natinal health initiatives, including the Millin Hearts campaign Selected CQMs must cver at least 3 f the Natinal Quality Strategy dmains (See Measure Selectin Prcess belw.) Hspitals and CAHs must reprt n 16 f the 29 apprved CQMs Selected CQMs must cver at least 3 f the Natinal Quality Strategy dmains (See Measure Selectin Prcess belw.) Beginning in 2014, all Medicare-eligible prviders beynd their first year f demnstrating meaningful use must electrnically reprt their CQM data t CMS. (Medicaid EPs and hspitals that are eligible nly fr the Medicaid EHR Incentive Prgram will electrnically reprt their CQM data t their state.) See Reprting Optins fr EPs and Reprting Optins fr Hspitals and CAHs belw fr mre infrmatin. 1

2 Measure Selectin Prcess CMS selected the recmmended cre set f CQMs fr EPs based n analysis f several factrs: Cnditins that cntribute t the mrbidity and mrtality f the mst Medicare and Medicaid beneficiaries Cnditins that represent natinal public health pririties Cnditins that are cmmn t health disparities Cnditins that disprprtinately drive healthcare csts and culd imprve with better quality measurement Measures that wuld enable CMS, States, and the prvider cmmunity t measure quality f care in new dimensins, with a strnger fcus n parsimnius measurement Measures that include patient and/r caregiver engagement In additin, CMS selected all CQMs t align with the Department f Health and Human Services Natinal Quality Strategy pririties fr health care quality imprvement. These dmains include: Patient and Family Engagement Patient Safety Care Crdinatin Ppulatin and Public Health Efficient Use f Healthcare Resurces Clinical Prcesses/Effectiveness When selecting their CQMs t reprt, EPs, eligible hspitals, and CAHs must select CQMs that cver at least three f these six dmains. A cmplete list f 2014 CQMs and their assciated Natinal Quality Strategy dmains will be psted n the CMS EHR Incentive Prgrams website ( in the future. CMS will als pst the recmmended cre set f CQMs fr EPs. Reprting and submissin perids fr EPs, Hspitals, and CAHs in their first year f Meaningful Use submitting CQMs via attestatin beginning with CY/FY 2014 Prvider Reprting Perid fr First Year f Meaningful Use (Stage 1) Submissin Perid fr First Year f Meaningful Use (Stage 1)* EP 90 cnsecutive days Anytime immediately fllwing the end f the 90-day reprting perid, but n later than February 28 f the fllwing calendar year. Hspital/CAH 90 cnsecutive days Anytime immediately fllwing the end f the 90-day reprting perid, but n later than Nvember 30 f the fllwing fiscal year. *Fr purpses f aviding a payment adjustment, Medicare EPs and eligible hspitals that are in their first year f demnstrating meaningful use in the year immediately preceding a payment adjustment year must submit their CQM data n later than Octber 1 (EPs) r July 1 (eligible hspitals) f such preceding year. 2

3 Reprting and submissin perids fr EPs, Hspitals, and CAHs beynd their first year f Meaningful Use submitting CQMs electrnically beginning with CY/FY 2014 Fr 2014 nly, all prviders regardless f their stage f meaningful use are nly required t demnstrate meaningful use fr a three-mnth EHR reprting perid. Medicare prviders can either reprt their CQMs fr the entire year r select an ptinal three-mnth reprting perid fr CQMs that is identical t their three-mnth reprting perid fr meaningful use. Fr Medicare prviders, this 3-mnth reprting perid is fixed t the quarter f either the fiscal (fr eligible hspitals and CAHs) r calendar (fr EPs) year in rder t align with existing CMS quality measurement prgrams, such as the Physician Quality Reprting System (PQRS) and Hspital Inpatient Quality Reprting (IQR). CMS is permitting this ne-time three-mnth reprting perid in 2014 nly s that all prviders wh must upgrade t 2014 Certified EHR Technlgy will have adequate time t implement their new Certified EHR systems. In subsequent years, the reprting perid fr clinical quality measures wuld be the entire calendar year (fr EPs) r fiscal year (fr eligible hspitals and CAHs). EP Prvider Hspital/CAH Optinal Reprting Perid in 2014* Calendar year quarter: January 1 March 31 April 1 June 30 July 1 September 30 Octber 1 December 31 Fiscal year quarter: Octber 1 December 31 January 1 March 31 April 1 June 30 July 1 September 30 Reprting Perid fr Subsequent Years f Meaningful Use (Stage 1 and Subsequent Stages) 1 calendar year (January 1 - December 31) 1 fiscal year (Octber 1 - September 30) Submissin Perid fr Subsequent Years f Meaningful Use (Stage 1 and Subsequent Stages) 2 mnths fllwing the end f the reprting perid (January 1 - February 28) 2 mnths fllwing the end f the reprting perid (Octber 1 - Nvember 30) *NOTE: The ptinal quarter reprting perids have the same submissin perid as a full year reprting perid fr electrnic submissin. 3

4 Reprting Optins fr EPs Categry EPs in First Year f Demnstrating Meaningful Use* Data Payer Submissin Reprting Schema Aggregate All payer Attestatin Submit 9 CQMs (includes adult and pediatric recmmended cre CQMs), cvering at least 3 NQS dmains EPs Beynd the First Year f Demnstrating Meaningful Use Optin 1 Aggregate All payer Electrnic Submit 9 CQMs (includes adult and pediatric recmmended cre CQMs), cvering at least 3 NQS dmains Optin 2 Patient Medicare Electrnic Satisfy requirements f PQRS grup reprting ptins using CEHRT Grup Reprting (nly EPs Beynd the First Year f Demnstrating Meaningful Use)** EPs in an ACO (Medicare Shared Savings Prgram r Pineer ACOs) EPs satisfactrily reprting via PQRS grup reprting ptins Patient Patient Medicare Medicare Electrnic Electrnic Satisfy requirements f Medicare Shared Savings Prgram f Pineer ACOs using CEHRT Satisfy requirements f PQRS grup reprting ptins using CEHRT *Attestatin is required fr EPs in their first year f demnstrating meaningful use because it is the nly reprting methd that wuld allw them t meet the submissin deadline f Octber 1 t avid a payment adjustment. **Grups with EPs in their first year f demnstrating meaningful use can reprt as a grup, hwever individual EPs wh are in their first year must attest t their CQM results by Octber 1 t avid a payment adjustment. 4

5 Reprting Optins fr Hspitals and Critical Access Hspitals Categry Hspitals in First Year f Demnstrating Meaningful Use* Data Payer Submissin Reprting Schema Aggregate All payer Attestatin Submit 16 CQMs, cvering at least 3 NQS dmains Hspitals/CAHs Beynd the First Year f Demnstrating Meaningful Use Optin 1 Aggregate All payer Electrnic Submit 16 CQMs, cvering at least 3 NQS dmains Optin 2 Patient Sample - all payer Electrnic Submit 16 CQMs, cvering at least 3 NQS dmains Manner similar t the 2012 Medicare EHR Incentive Prgram Electrnic Reprting Pilt *Attestatin is required fr eligible hspitals in their first year f demnstrating meaningful use because it is the nly reprting methd that wuld allw them t meet the submissin deadline f July 1 t avid a payment adjustment. 2. Medicaid EHR Incentive Prgram 2013 and Beynd EPs, eligible hspitals, and CAHs participating nly in a Medicaid EHR Incentive Prgram will submit their CQM data directly t their State. Each State is respnsible fr sharing the details n the prcess fr electrnic reprting with its prvider cmmunity. Subject t CMS s prir apprval, the prcess and the timeline are within the States purview. 5