Making Meaningful Use Reports Meaningful
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1 Making Meaningful Use Reports Meaningful October 14 th,
2 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion - 1 -
3 MAEHC Mission: Facilitate universal EHR adoption Company launched September 2004 Non-profit registered in the Commonwealth of Massachusetts CEO on board January 2005 Backed by broad array of 34 nonprofit MA health care stakeholders - 2 -
4 MAeHC Selected three pilot sites from 35 Applicants: Brockton, Newburyport, North Adams Provided EHRs to ~600 clinicians practicing in over 200 office locations Created health information exchanges connecting the physicians with each other and with the hospitals Created a quality data center to extract clinical data from EHRs to evaluate effectiveness and measure performance - 3 -
5 MAeHC architecture and data flows Analysis and Reporting Outcomes analysis Benchmarking Reporting to plans, others? Quality Data Center Community-level: HIE Brockton Newburyport North Adams Provider-level: EHR - 4 -
6 Since the pilot program, MAeHC has expanded its experience base and involvement in a variety of projects 300 Physician EHR implementation Beth Israel Deaconess Physician Organization (BIDPO) Community-wide EHR Implementation and HIE planning project Large Healthcare Foundation HEAL 5 New York New York State Department of Health and New York ehealth Collaborative (NYeC) HEAL 10 New York Adirondack Region Patient Centered Medical Home Pilot State-level HIE technical services vendor procurement Missouri, North Carolina State Level Health Information Exchange Strategic and Operational Plan Development New Hampshire Regional Extension Center planning, deployment, and operations New York, Massachusetts, Rhode Island, New Hampshire - 5 -
7 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion - 6 -
8 What is a measure? Meas ure n. A standard: a basis for comparison; a reference point against which other things can be evaluated; they set the measure for all subsequent work. v. To bring into comparison against a standard
9 We know we can t measure everything Not everything that counts can be counted, and not everything that can be counted counts. ~Albert Einstein But You can t improve what you don t measure - 8 -
10 Why measure? Measures drive improvement. Teams of healthcare providers who review their performance measures are able to make adjustments in care, share successes, and probe for causes when progress comes up short all on the road to improved patient outcomes. Measures inform consumers. As a growing number of measures are publicly reported, consumers are better able to assess quality for themselves, and then use the results to make choices, ask questions, and advocate for good healthcare. Some providers now post performance measures on their websites, and consumers can consult national sources such as and Measures influence payment. Increasingly, private and public payers use measures as preconditions for payment and targets for bonuses, whether it is paying providers for performance or instituting nonpayment for complications associated with NQF s list of Serious Reportable Events. Source: NQF
11 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
12 Linkage of Health IT and measurement Data Sources Capture the right data, in the right format (CPT, ICD, LOINC) CQM Calculate the performance measure EHR and HIT Tools Provide real-time information to the clinician with decision support E-Infrastructure Publicly report for accountability, payment, public health, and comparative effectiveness Source: NQF
13 Meaningful Use CQM objective Improve quality, safety, efficiency and reduce health disparities Objective Report ambulatory clinical quality measures to CMS or the States: Core: Hypertension, Tobacco Use Assessment & Cessation Intervention, Adult Weight Screening (NQF 13, 28, 421 or PQRI 128) Menu: Must choose 3 measures to report Standard For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures. Requires only Yes/ No Attestation Exclusion Criteria X None
14 CQM is based on current standards NQF, PQRI Population may be all patients, patients seen, or unique patients
15 Key to CQM success Keep required data in reportable fields Code and document completely; missing values or missing information = lower performance Information should be kept as structured data in searchable/sortable fields rather than free-text Establish workflows and maximize staff capabilities to enter data elements, i.e. support staff can enter problems, medications, allergies and history Patient/Medical/System reasons for exclusions should be documented and coded; helps to improve scores by legitimately reducing the denominator
16 Meaningful Use CQM issues Must select 3 additional CQMs that your EHR is certified to submit Centricity meets the following clinical quality measures: NQF 0013, NQF 0024, NQF 0028, NQF 0038, NQF 0041, NQF 0059, NQF 0061, NQF 0064, NQF CQM reporting tool must be certified if it is outside your EHR (MQIC) Use bundled EHR when registering using additional software packages Incorrect data mapping by vendor understanding triggers for calculations Submission can be 0/0-15 -
17 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
18 CQM data must be relevant, timely and actionable What you did What you are doing What you should do Historical data based on claims collected post visit with time delay Current data incorporating erx, orders and some test results CDS based on real time ICD/CPT data, erx, results, and approved protocols EHR Implementation and Adoption
19 CQM data must be relevant, timely and actionable CMS has acknowledged that the CQM reporting requirement in Stage 1 is no more than that a reporting requirement meant to get physicians comfortable with the process of reporting. CMS is under no illusions that the data collected will be meaningful as a measure of the level or quality of care being provided. Many physicians will be reporting on problems for which they are not treating the patients, which means that measure numerators will be zero (or very low) and that duplicate data will be submitted by different physicians for the same patients for the same conditions, which will result in an underestimation of the true care being delivered
20 Individual scores Source: MAeHC QDC
21 Peer-to-Peer comparison Source: MAeHC QDC
22 Benchmark against standards Source: MAeHC QDC
23 Other ways your data warehouse can present data? Longitudinal scorecards to show variation over time Scorecards by payer to facilitate Quality Contracts (PFP) Scorecards by CQM for treatment comparison Local, regional and national benchmarks
24 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
25 Measures are getting better defined, but measure proliferation is a growing concern Meaningful Use Stage 1 PQRS NCQA HEDIS /PCMH NQF 44 measures measures Numerous measure choices Measures Intent of measures often are very similar, but very few if any measures have same definitions across categories
26 What the future holds for MU Stage 2 and Stage
27 Future framework for the reporting of CQM The Stage 2 recommendations for CQM reporting that the HIT Policy Committee has forwarded to CMS significantly expand on the Stage 1 measures in an attempt to address a broader set of factors that affect quality, as well as to be relevant to a wider set of physicians, including specialists. Providers would report on some number of the core measures, (between 5 and all 8 or 9 is the recommendation), and at least one measure from each of the 6 menu domains. The core quality measure set would include all of the core and alternate core measures from Stage 1 and an additional 2 measures related to care coordination. The intention is that all providers (including specialists) will find measures relevant to their specialty in the core set as well as in each of the domains
28 Future framework for the reporting of CQM The intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of physicians. All providers will find measures relevant to their specialty in the core set as well as in each of the domains
29 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
30 The health reform law included a section that directed the HHS Secretary to establish a Shared Savings Program Not later than January 1, 2012, the Secretary shall establish a shared savings program that promotes accountability for a patient population and coordinates items under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery Allows groups of providers of services and suppliers to manage and coordinate care for Medicare fee-for-services beneficiaries through an Accountable Care Organization or ACO Source: Social Security Act Sec
31 A shift to ACOs will increase demand for information Clinical information to support: Care coordination Evidence Based Medicine (EBM) Risk adjustment for patient population Immature In early use Mature Quality information to support: Reporting on clinical processes and outcomes Reporting on patient/caregiver experience of care Reporting on utilization (e.g., Preventable hospital admissions) Referral decisions (e.g., quality score for a lab, specialist practice, or provider) Administrative/financial information to support: Payment FFS Payment Capitation, bundled payment, P4P Payment Shared savings Referral decisions (e.g., rate cards for a lab, specialist practice, or provider) Assignment of patients to ACO
32 A shift to ACOs will increase demand for integration Meaningful Use capability Clinical integration capability Accountable care capability Enterprise Integration & Management Business integration Population, Risk, and Financial Management Case management & longitudinal viewing Population, Risk, and Financial Management Case management & longitudinal viewing Business alignment Team-based care Patient engagement Measurement & Reporting Registries & Repositories Measurement & Reporting Registries & Repositories Measurement & Reporting Registries & Repositories Performance mgmt Population mgmt Utilization mgmt Case facilitation Clinical messaging EHR functions Clinical messaging EHR functions Clinical messaging EHR functions Clinical messaging EHR functions Become electronic Fill in gaps in care transitions Independent actors IPA/PHO ACO IDN
33 EHR penetration will lead to proliferation of interfacing requirements Clinicians will soon face too many measure definitions and too many proprietary reporting methods to respond to ehr ehr ehr ehr Both sides will be exposed to ongoing technology and market changes Measure recipients will face too many disparate systems, incomplete implementations, and inaccurate measure reports Payor Contracts CMS MU CMS PQRS Public health Others?
34 Is there a better way? ehr ehr ehr ehr Data Warehouse Payers CMS PQRS Others CMS MU Public health
35 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
36 Federal Health IT Strategic Plan
37 Interoperability Goals Drive Roadmap WHAT we want to do Facilitate Information Exchange to support Meaningful Use of EHRs (Goal 1, Objective B) Ensure that HIE takes place across individual exchange models, and advance health systems and data interoperability (Strategy 1.B.3) WHY? INTEROPERABILITY GOALS Improved care coordination Patient access and engagement Improved decision-making Population health / learning health care system HOW we will do it STANDARDS Standards& Interoperability Framework SERVICES State HIE Cooperative Agreement Direct Project NwHINInfrastructure POLICIES Governance regulations MU regulations S&C regulations State policy levers 36
38 Eyes on the Prize: National Quality Strategy Aims Better Care: Improve quality, by making health care more patient-centered, reliable, accessible, and safe Healthy People and Communities: Improve health of population Affordable Care: Reduce cost of quality health care Six Priorities and Goals to help focus public and private efforts: Safer Care: eliminate preventable health care-acquired conditions Effective Care Coordination Person- and Family-Centered Care Prevention and Treatment of LeadingCauses of Mortality: prevent and reduce harm caused by cardiovascular disease Support Better Health in Communities Make Care More Affordable National Quality Strategy
39 Agenda MAeHC experience Why we measure HIT and CQM Using CQM data What is the future of CQM Changing healthcare landscape National Quality Strategy Questions, comments, discussion
40 How Measures Will Serve Our Future Measures are becoming both more precise and more complex. The next generation of measures will span healthcare settings and episodes of care to present a more complete picture of care. In the public arena, reporting of measures will become clearer and easier for patients and their families to understand and use. Wider adoption of electronic health records (EHRs) can spur measure use enormously. A tremendous boom for patient care and patient experience, EHRs put all the relevant information, including a patient s medical history, at a provider s fingertips. Patients can avoid duplicate tests or imaging. EHRs will also make measurement and performance data available on a real-time basis, making healthcare much more responsive to patient needs. Without good data, healthcare systems simply cannot accurately measure and assess performance. Source: NQF
41 Jeff Loughlin Jen Monahan Leo McNamara Executive Director Program Coordinator Project Manager (508) (603) (781) Nancy Fennell Jaime Dupuis Dave Delano Practice Consulting Practice Consulting CAH Consultant (603) (603) (339) Regional Extension Center of New Hampshire c/o New Hampshire Medical Society 7 North State Street Concord, NH Tel: Fax: nh-rec@maehc.org
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