MU Stage 2: Domains and Details. Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014

Transcription

1 MU Stage 2: Domains and Details Anita Karcz MD Chief Medical Officer Institute for Health Metrics February 5, 2014

2 Welcome to the Webinar If you cannot hear any sound or if you get a busy signal, hang up and dial in again, making sure that you dial the correct access code. If you have entered the incorrect code, you might not get an error message. If you have not yet received a copy of the slides, me and I will get you a copy anita@healthmetrics.org All attendees are on mute: to ask a question, type it into the Q&A box in the control panel on your screen To minimize the control panel, click on the arrow near the top of the vertical bar that is on the left side of the control panel:

3 Themes Stage 2 Measure Reporting New Criteria Starting in 2014, providers participating in the EHR Incentive Programs who have met Stage 1 for two or three years will need to meet meaningful use Stage 2 criteria. Improving Patient Care Stage 2 includes new objectives to improve patient care through better clinical decision support, care coordination and patient engagement.

4 How QI Reporting Programs line up by FY Program Purpose Measures FY 2014 FY 2015 FY 2016 Hospital IQR Monitor quality of care 72 chart abstracted: AMI, HF, PNE, SCIP; Claim based: mortality, readmits for AMI, HF, PNE; Pt Safety:HAI, HCAPS, Immunization and structural measures ValueBased Purchasing EHRIncentive Program (Meaningful Use) TransformMedicare from passive payer to prudent purchaser of services UsingCEHRT to improve quality, safety and reduce health disparities, engage families, improve care coordination, maintain privacy Domains forgrouping and scoring: Clinical Process of care, Pt experience of care (HCAPS), Outcome (CLABSI and PSI-90) and Efficiency Core/Menuand CQM for Stage 1 and Stage 2 59 measures 60 measures Domains will be weighted in FY 2015 Core/Menuand CQM Stage 1 and Stage 2 Core/Menu and CQM Stage 1 and Stage 2

5 Critical for Success Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs Quality department must be involved with CQMs 2013 IHM Services. 5

6 CQM Domains

7 16 out of 29 menu CQM s (Table 9 of the Final Rule) Of 16 measures, one measure must be selected from 3 of the 6 HHS National Quality Strategy domains: Patient & Family Engagement Patient Safety Care Coordination MU 2 CQM Domain Reporting Efficient Use of Healthcare Resources Population and Public Health Clinical Processes and Effectiveness Note: These Domains align directly with the HHS National Quality Strategy Goals

8 Domain Definitions Patient & Family Engagement Reflect potential to improve patient-centered care and the quality of care delivered to patients Emphasize the importance of collecting patient-reported data Ability to impact care at the individual level as well the population level through greater involvement of patients, and families in decision making, self care, activation and understanding of their health condition and effective management Patient Safety Reflect safe delivery of clinical services that reduce harm to patients and reduce the burden of illness Enable longitudinal assessment of condition specific, patient-focused episodes of care Care Coordination Demonstrate appropriate and timely sharing of information and coordination for clinical and preventive services Emphasize the care delivery team and their work with patients, caregivers and families to improve appropriate and timely patient care and team communication Federal Register / Vol. 77, No. 171 / Tuesday, September 4, 2012 / Rules and Regulations/ p 54054

9 Domain Definitions Efficient Use of Healthcare Resources Reflect the efforts to significantly improve outcomes and reduce errors Impact and benefit a large number of patients Emphasize the use of evidence to best manage highlight priority conditions and determine appropriate use of healthcare resources Population and Public Health Reflect the use of clinical and preventive services and achieve improvements in the health of the population served with the focus on the leading causes of mortality Outcome-focused and have the ability to achieve longitudinal measurement that will demonstrate improvement in the health of the US population Clinical Processes and Effectiveness Reflect clinical care processes linked to outcomes based on evidence and practice guidelines Federal Register / Vol. 77, No. 171 / Tuesday, September 4, 2012 / Rules and Regulations/ p 54054

10 Domains Across Programs/FY MU 2 Domains 2014 VBP Domains IQRP/VBP Patient & Family Engagement (ED 1, 2; STK 8; VTE 5; HMPC) Patient Safety (VTE1, 2, 6; Healthy NB; SCIP INF 1, 9) Care Coordination (STK1o) Efficient Use of Healthcare Resources (PN 6; SCIP-INF 2) Patient Experience of Care (HCAHPS) Safety (PSI Composite, CLABSI) Care Coordination (HF 4;30 day mortality AMI, HF, PNE) Efficiencyand Cost Reduction (Medicare Spending per Beneficiary measure) Patient and Caregiver Experience of Care (HCAHPS) Patient Safety (SCIP and HAI) Care Coordination (30 day mortality AMI, HF, PNE) Efficiency (Medicare Spending per Beneficiary measure) Population and Public Health Community/PopulationHealth Population/Community Health (the global immunization) Clinical Processes and Effectiveness (STK 2, 3, 4, 5, 6; VTE 3, 4; AMI 2, 7a, 8a, 10; PC-01; EHDI-1; Breast milk) Clinical Process of Care (AMI 7a, 8; HF 1; PN 3b,6; SCIP INF 1, 2, 3, 4, 9, SCIP Card 2, SCIP CTE 1, 2) Clinical Quality (AMI, HF, PN, STK, and VTE)

11 Stage 1 to Stage 2 Domains: CQM Stage 1 and Stage 2 Title ED-1: Arrival to Admit ED-2: Admit Decision to Depart STK-2: Antithrombotics STK-3: Anticoagulation w/ Afib STK-4: Thrombolytic in 2 Hr Domain Patient and Family Engagement. Patient and Family Engagement. Clinical Process / Effectiveness. Clinical Process / Effectiveness. Clinical Process / Effectiveness. STK-5: Antithrombotic in Hospital Clinical Process / Effectiveness. STK-6: Statin Clinical Process / Effectiveness. STK-8: Stroke Education Patient and Family Engagement. STK-10: Rehab Assess Care Coordination. VTE-1: After Arrival Patient Safety. VTE-2: After ICU Admit Patient Safety. VTE-3: Anticoag Overlap Clinical Process / Effectiveness. If hospital reports for MUS 2 the same CQMs that were reported for MUS 1, then only one additional indicator is required from any domain to make 16 indicators. VTE-4: Platelets and UFH VTE-5: VTE Education VTE-6: Potential Prevention Clinical Process / Effectiveness. Patient and Family Engagement. Patient Safety. Federal Register / Vol. 77, No. 171 / Tuesday, September 4, 2012 / Rules and Regulations/ p 54054

12 Stage 2 Domains: New CQMs Stage 1 and Stage 2 Title Domain Abbreviated Description ED-3: Arrival to Depart Care Coordination Arrival to depart median time for patients discharged from ED AMI-2: Aspirin at Discharge Clinical Process / Effectiveness. AMI patients that receive aspirin at discharge AMI-7a: Fibrinolytic within 30 minutes Clinical Process / Effectiveness. AMI patientswith ST elevation/lbbb on ECG AMI-8a: PCI within 90 minutes Clinical Process / Effectiveness. AMI patientswith ST elevation/lbbb on ECG AMI-10: Statin at Discharge Clinical Process / Effectiveness. AMI patients that receive statin at discharge PC-01: Elective Delivery prior to 39 weeks PN-6: CAP Antibiotic Selection SCIP-INF-1: Antibiotic 1 Hr Prior to Incision Clinical Process / Effectiveness. Efficient Use of Healthcare Resources. Patient Safety. Vaginal or C-section Initial antibiotic received in first 24 hours Received antibiotic SCIP-INF-2: Prophylactic Antibiotic Selection SCIP-INF-9: Urinary Catheter Removal POD 1 or 2 Efficient Use of Healthcare Resources. Patient Safety. Antibiotic specific to surgery Catheter removal HMPC: Document to Patient Patient and Family Engagement. Home Management Plan of Care given to patient or caregiver Exclusive Breast Milk Clinical Process / Effectiveness. Newborn only receives breast milk during entire hospitalization Healthy Term Newborn Patient Safety. Single live births without significant complications EHDI-1a: Hearing Screening Prior to Discharge Clinical Process / Effectiveness. Newborns receiving screening Federal Register / Vol. 77, No. 171 / Tuesday, September 4, 2012 / Rules and Regulations/ p 54054

13 CQM Measures Things to Remember

14 CQMs 2011 and 2014 Even though CQMs have the same name, they are not the same emeasures are not identical to the manual abstracted measures that they were derived from 2013 IHM Services. 14

15 Summary of Changes in Stage 1 CQMs for Stage 2 version September and December 2012 Measures: STK, VTE, ED Expanded time frame and variables by which a palliative care patient can be identified and therefore appropriately excluded for a number of measures Location is no longer used as an identifier of type of patient More value sets and more inclusive value sets Additional logic added to clarify items Some denominator exclusions became population exclusions Expansion of window for studies/meds completed prior to admission Removed exclusions and added exclusions in denominator or numerator New concept: in order for activities/treatment in the ED to be associated (would count) as part of the encounter experience the time between the end of the ED visit and the beginning of the inpatient admission has to 60 minutes or less Dec 2012 release with 303 value sets

16 Summary of Changes in Stage 2 CQMs version April 2013 Measures: VTE, STK, PNE, AMI, SCIP, PC Consolidated value sets to include dx, treatment and conditions for single indicator in one value set Combine value sets where information was similar or duplicative Added more value sets and more grouping value sets Remove redundant logic Shifted criteria from denominator exclusion to denominator exception in AMI Added LOS criteria Added denominator exclusions for normal CT in PNE Added logic to manage start/end times for multiple procedures in SCIP April 2013 release 346 value sets and increased size of value sets due to grouping

17 Continual Change Version 2 espec Version 3 espec

18 CMS comments on Stage 2 CQMs We expect eligible hospitals and CAHs will select measures that best apply to their patient mix. As we proposed, if an eligible hospital s or CAH s CEHRT does not contain patient data for at least 16 CQMs covering at least 3 domains, then the eligible hospital or CAH must report the CQMs for which there is patient data and report the remaining required CQMs as zero denominators as displayed by their certified EHR technology. In the unlikely event that there are no CQMs applicable to the eligible hospital s or CAH s patient mix, eligible hospitals or CAHs must still report 16 CQMs even if zero is the result in either the numerator or the denominator of the measure.

19 From ONC Question: 2. There are times when a provider may expect that they will have patients in the denominator for the measure, based on doing some case mix analysis ahead of time, but especially due to the shorter reporting period of 3 months/quarter for 2014, they end up with a zero denominator. In that case, they may not have done the work to build out and collect an alternate measure by the time they realize this. Is it acceptable for them to report the zero denominator for that measure? Comment from CMS: Response to #2: Yes, if they have zero patients that fit the denominator criteria during the reporting period they are using, they can report a zero denominator. (NOTE: They would still need to have CEHRT that is certified for each of the CQMs for which they report zero denominators) IHM Services. 19

20 The Bottom Line If the hospital documents a simple case mix analysis to justify their choices of CQMs, then they are free to report zeros on their CQMs without concern. The case mix analysis should show that they chose CQMs that were no less likely to have any denominator than the CQMs they didn t choose IHM Services. 20

21 CQMs and Patient Volume FY2014 In order to align with the Hospital IQR Program, we will adopt a similar policy for all eligible hospitals and CAHs participating in the EHR Incentive Program, whereby hospitals with 5 or fewer inpatient discharges per quarter or 20 or fewer inpatient discharges per year (Medicare and non-medicare combined) as defined by a CQM's denominator population would be exempted from reporting on that CQM IHM Services. 21

22 CQM Updates From CMS: Updates to CQM specifications may be provided annually approximately 6 months in advance of the FY/CY for hospitals and EPs, respectively. Fog and limited visibility on March IHM Services. 22

23 On that upbeat note me for a copy of the slides anita@healthmetrics.org me if you would like a copy of our difficulty rating document for MU CQMs anita@healthmetrics.org 2013 IHM Services. 23

24 References Guidance/Legislation/EHRIncentivePrograms/eCQM_Library.html Health Information Knowledgebase Value Set Authority Center: Meaningful Use Core and Menu Stage 2: CMS Stage 2: Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_Meanin gfulusespecsheet_tablecontents_eligiblehospitals_cahs.pdf

25 References Page%2FQnetTier2&cid= Instruments/hospital-value-basedpurchasing/index.html?redirect=/Hospital-Value-Based-Purchasing

26 References HITECH Act, title XIII of division A and title IV of division B of the Recovery Act. Pub. L. No , div. A, tit. XIII, 123 Stat. 115, and div. B, tit. IV, 123 Stat. 115, (2009) Mekhijian HS, Kumar RR, Kuehn L, t. al. Immediate benefits realized following implementation of physician order entry at an academic medical center, JAMIA. 2002; 9: National Quality Forum, Quality Data Model. Information is available at: aspx. Potts AL, Barr FE, Gregory DF, et. al. Computerized physician order entry and medication errors on a pediatric critical care unit. Pediatrics. 2004: 113: VanLare JM, Conway PH. Value-Based Purchasing --- National Programs Move from Volume to Value, N Engl J Med. 2012; 367: July 26, 2012.