CQMs. Clinical Quality Measures 101

Transcription

1 CQMs Clinical Quality Measures 101

2 BASICS AND GOALS In the past 10 years, clinical quality measures (CQMs) have become an integral component in the Centers for Medicare & Medicaid Services (CMS) drive to improve quality, reduce costs and expand access to healthcare for Medicare and Medicaid beneficiaries and, ultimately, for all patients in the U.S. Although quality-reporting programs such as meaningful use provide incentives to help providers implement and use electronic health records (EHRs) to collect and report on clinical data, practices often need help deciding what data to collect, which measures to report on, and how to best use their EHRs to do so. The following provides you with the basic information you need to choose appropriate CQMs for your practice, and offers tips on how to use your EHR to store the data in a structured format. Quality measures and incentive programs As part of meaningful use (MU) and other quality-reporting programs, eligible CQM (EPs) must report on a selection of clinical quality measures (CQMs) set forth by CMS. Significant changes have been made to how CQMs are used under CMS quality-reporting programs, including the Physician Quality Reporting System (PQRS) and the EHR Incentive Program (meaningful use). CMS has worked hard to align the quality-reporting requirements across the various programs. As a result, providers have the option to use the same set of quality measures to report CQMs for both PQRS and meaningful use. What they gauge Health outcomes Efficient use of healthcare resources Clinical processes Care coordination Patient safety Patient engagement Where the data comes from In the past, quality measures primarily used data from claims, but as technology has improved and become more prominent in the healthcare setting, many quality measures now use data from the provider s EHR. How CMS uses the data Think of CQMs as part of a system of care quality checks and balances. By requiring providers to track and record patient treatment via electronic health records, CMS holds eligible professionals accountable for providing safe, efficient and timely patient-centered care. To make policy decisions around quality To inform the public about the level of care provided within a given organization or by a particular provider To improve the quality of healthcare nationwide by focusing on programs designed to target significant weaknesses within our healthcare system 2

3 SELECTION AND REPORTING Recommended core sets For 2014, CMS has identified two recommended core sets of CQMs one for adults and one for children. Eligible professionals are encouraged to report from the recommended core set that best suits their scope of practice and patient population. Additionally, all providers must select CQMs from at least three of the six key healthcare policy domains recommended by the Department of Health and Human Services National Quality Strategy: Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness A complete list of 2014 CQMs and their associated National Quality Strategy domains are posted on the recommended core set of CQMs for eligible providers all focusing on high-priority clinical conditions. In 2014, all providers regardless of whether they are in Stage 1 or Stage 2 of meaningful use will be required to report on the 2014 CQMs finalized in the Stage 2 rule, which stipulates: EPs must report on 9 out of 64 total CQMs: 9 ecqms for adult populations that meet all of the program requirements 9 ecqms for pediatric populations that meet all of the program requirements 3

4 Adult recommended core measures Controlling high blood pressure Use of high-risk medications in the elderly Preventive care and screening: Tobacco use: Screening and cessation intervention Use of imaging studies for low back pain Preventive care and screening: Screening for clinical depression and follow-up plan Documentation of current medications in the medical record Preventive care and screening: Body mass index (BMI) screening and follow-up Closing the referral loop: Receipt of specialist report Functional status assessment for complex chronic conditions Full table of recommended adult measures Pediatric recommended core measures Appropriate testing for children with pharyngitis Weight assessment and counseling for nutrition and physical activity for children and adolescents Chlamydia screening for women (16 to 24 years of age) Use of appropriate medications for asthma Childhood immunization status Appropriate treatment for children with upper respiratory infection (URI) ADHD: Follow-up care for children prescribed Attention-Deficit/ Hyperactivity Disorder (ADHD) medication Preventive care and screening: Screening for clinical depression and follow-up plan Children who have dental decay or cavities Full table of recommended pediatric measures For more information about clinical quality measures, visit 4

5 Why these specific measures? CMS selected the recommended core sets of clinical quality measures based on the following factors: Conditions that contribute to the morbidity and mortality of the most Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that are common to health disparities Conditions that disproportionately drive healthcare costs and could improve with better quality measurement Measures that would enable CMS, states and the provider community to measure quality of care in new dimensions, with a stronger focus on sparing measurement Measures that include patient and/or caregiver engagement For more detailed information on 2014 CQMs and electronic reporting options, download the 2014 Clinical Quality Measures Tipsheet. Choosing appropriate CQMs for your practice The following questions can help providers understand where opportunities for quality improvement exist and which measures are appropriate for tracking that improvement. Is the measure s population reflected in your patient mix? For example, a pediatrician should not choose a measure that excludes children. Does the measure correlate with specific diseases that are more prevalent or harder to control among your patients? For example, the practice may have many patients with diabetes, but few with asthma. Are you already using the measure for other quality measurement or reporting activities? Consider what the practice does for commercial payers, the state and other initiatives. Take advantage of overlaps to streamline your data collection and reporting activities. HELPFUL HINT FOR CHOOSING THE RIGHT CQMS Choose the top 10 or 20 diagnoses you see in your patient population as a whole, and match them with related CQMs. Is your EHR certified for the measure? Choosing clinical quality measures to report on for meaningful use can be a daunting task. It is suggested that you begin this process by looking at your patient population as a whole, and pulling out the top 10 to 20 diagnoses that you typically see. From there, you can match those diagnoses against the listing of clinical quality measures available, identify the best candidates that align with the most common diagnoses among your patients, and work with your vendor to ensure that your EHR system has the ability to track the measures you select. 5

6 Reporting CQMs To assess providers compliance and progress, most programs require that CQM data be reported. In order to capture and share patient data efficiently, providers need an EHR that stores data in a structured format. This structured data allows patient information to be easily retrieved and transferred, and allows the provider to use the EHR in ways that can aid patient care. Some of the EHR functions listed below can help improve the performance of this data: Confirm that the patient s problem list is up to date Determine if patients meet exclusion or exception criteria for the measure Determine if any patients are encountering specific barriers to treatment adherence Review any changes in vital signs Use clinical decision support to highlight missing services (for example, reminders for age appropriate vaccinations or cancer screenings) Review the patient s medications, if applicable Use eprescribing to obtain prescription and refill history Determine if there are any drug-drug or drug-allergy interactions Confirm that the patient s active medication and active medication allergy lists are up to date Perform a medication reconciliation if necessary Determine if there are barriers to medication adherence for the patient Engage the patient Be sure to provide updated clinical summaries at each visit Ensure information on the clinical summary is accurate for the patient (for example, a mammogram reminder for a double mastectomy patient would not be appropriate) 6

7 EPs ROLES IN CQM REPORTING Provider reporting of clinical quality measures Quality Initiative Who Reports CQMs Source of Data Provider Reporting Mechanism Purpose of Reporting EHR Incentive Program (meaningful use) Eligible Providers Electronic Medical Record Attestation or Group Practice Reporting Option (GPRO) Determine eligibility for EHR Incentive Physician Quality Reporting System Eligible Medicare Physicians Medical Records Group Practice Reporting Option (GPRO) Determine eligibility for PQRS Incentive payment Accountable Care Organizations Medicare Approval ACOs Medical Records, Surveys & Claims Group Practice Reporting Option (GPRO) Determine eligibility to share in savings Million Hearts Campaign Provider Volunteers Provider Determined Optional Prevent cardiac-related deaths Children s Health Insurance Program Medicaid & CHIP Agencies Claims N/A - State Reported Monitor and improve Quality for Medicaid & CHIP Beneficiaries Medicare Advantage Part C Medicare Health Plans Medical Records, Surveys & Claims Determined by Health Plan where applicable Provide publicly available quality ratings for Medicare Advantage Plans 7

8 WHAT ARE YOUR COLLEAGUES DOING? Greenway surveyed more than 500 providers to learn more about which CQMs they use to attest for meaningful use. The survey results offered great insight into the most-used CQM groups and the specific measures within each group. Of the providers polled in our survey 77% of EPs have attested for meaningful use Stage 1 77% plan to attest for meaningful use Stage 2 STAGE 1 7% 8% 77% 77% STAGE 2 8% 14% 9% YES NO, but PLAN TO attest YES, PLAN TO attest NO, with NO plans to attest DON T KNOW NO, with NO plans to attest DON T KNOW Top-ranked CQM groups Preventive Care and Screening (72%) Hypertension (59%) Diabetes (57%) Preventive Care and Screening 72% Hypertension 59% Diabetes 57% Others Include: Cancer Screening 45% Care Coordination/Patient Safety Measures 44% Asthma Measures 39% Pediatric Measures 32% Heart Failure, CAD, Atrial Fibrillation Measures 30% Mental Illness/Substance Abuse Measures 25% Elderly Care 23% Low Back Pain/Knee or Hip Replacement Measures 17% HIV/AIDS Measures 13% TVD Measures 10% Oncology Measures 8% Cataracts/POAG Measures 4% According to the Centers for Disease Control and Prevention (CDC), more than one-third of U.S. adults (34.9%) are obese. With a rising obesity rate and related health conditions, it s no surprise that these have become providers top CQM choices. 8

9 Drilling down: Preventive care and screening Americans are living longer, but with more chronic illness. This calls for more and more preventive care, placing smoking, obesity and high blood pressure at the top of the CQMs on which providers choose to report. Tobacco Use: Screening and Cessation Intervention 83% BMI: Screening and Follow-Up 76% Preventative Care & Screening: Influenza Immunization 67% Others Include: Screening for High Blood Pressure and Follow-up Documented 64% Cholesterol : Fasting Low-Density Lipoprotein (LDL-C) Testing 56% Screening for Clinical Depression & Follow-Up 43% Chlamydia Screening for Women 42% Risk-Satisfied Cholesterol - Fasting Low-Density Lipoprotein (LDL-C) 37% Pregnant Women that had HBsAG Testing 30% Top-reported pediatric measures Weight assessment and ADHD top the list of the reported Pediatric Clinical Measures. Over the past three decades, childhood obesity rates in America have tripled, and today, nearly one in three children in America is overweight or obese. And an estimated 6.4 million children ages 4 through 17 had received a diagnosis of attention deficit hyperactivity disorder (ADHD) at some point in their lives. About two-thirds of those with a current diagnosis receive prescriptions for stimulants such as Ritalin or Adderall. Childhood Immunization Status (NQF 0038) Weight Assessment & Counseling for Nutrition and Physical Activity for Children and Adolescents (NQF 024) 85% 96% ADHD: Follow-Up Care for Children Prescribed Medication (NQF 0108) Appropriate Treatment for Children with Upper Respiratory infection (URI) (NQF 0069) Appropriate Testing for Children with Pharyngitis (NQF 0002) 61% 71% 67% Primary Caries Prevention and Intervention as Offered by Primary Care Providers, including Dentists 53% Maternal Depression Screening (NQF 1401) 44% Hemoglobin A1c Test (NQF 0060) 43% Children Who have Dental Decay or Cavities 43% 9

10 CHOOSE GREENWAY Each physician and practice is different. Choose a partner who understands that and treats you accordingly. To see why thousands of your peers have selected Greenway Health as their EHR and health information solutions partner, visit greenwayhealth.com or call (866) PrimeSUITE, the integrated EHR and practice management solution from Greenway, is certified for meaningful use Stage 2 and prevalidated for patient-centered medical home (PCMH). 100 Greenway Blvd. Carrollton, GA Phone: Fax: greenwayhealth.com 2014 Greenway Health, LLC. All rights reserved. Cited marks are the property of Greenway Health, LLC or its affiliates. Other company or product names are the property of their respective owners. 10