Quality Measure Reporting of Ambulatory EMR in the USA

Transcription

1 Quality Measure Reporting of Ambulatory EMR in the USA The stepping stone towards EHR adoption in the USA April 2011 Roberto Schliesser VP telemedicine Solutions ewave MD

2 The Cost of Healthcare Is Destroying the Competitiveness of the U.S.A. USA USA Germany Italy Japan Israel China Health Care Costs $ 8,000 $ 3,500 $2,700 $ 2,700 $ 2,200 $ 100 % GDP 17% 10% 9% 8% 8% 4% Life Expectancy Smokers 20% 32% 22% 30% 24% 32% Obesity 37% 14% 10% 4% 27% 4% Ambulatory Visits/Capita Gross National Income/Capita N/A $46,000 $34,000 $31,000 $34,000 $27,000 $5,000 The Average cost of an MRI is $100 in Japan and $1,000+ in the U.S. Source: World Health Organization OECD CDC CIA Fact Book

3 Bush and Obama Have Created The New World Order of Healthcare 3

4 Winston Churchill The Americans will always do the right thing... After they've exhausted all the alternatives. ti 4

5 Kathleen Sebelius Secretary of the Department of Health and Human Services When electronic health records are well designed and implemented correctly, they can be a powerful force for reducing errors, lowering costs, raising quality of care, and increasing doctor and patient satisfaction. 5

6 Dr. David Blumenthal National Coordinator for H.I.T We need a system in place to be surethat patient information is where it s needed. It is a core technical competence for physicians to know how to use an EHR. 6

7 2000 To Err Is Human Would You Fly if a 747 Crashed Every Day? U.S. Deaths/Year Hospital Acquired Infections million 63,000 Adverse Drug Events, Medical Errors 4 35,000 Traffic Accidents 3 34,000 Breast Cancer 2 41,000 AIDS 1 15, Centers for Disease Control and Prevention 2. American Cancer Society, Cancer Facts & Figures National Highway Traffic Safety Administration, Traffic Safety Facts, August To Err is Human, Building a Safer Health System By Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors. Committee on Quality of Healthcare in America, Institute of Medicine, National Academy Press, Washington, D.C. (2000)

8 McGlynn s U.S. Adults Receive 55% of Recommended Care Percent of Recommended Care Received Overall Breast Cancer Hypertension Asthma Pneumonia Hip Fracture Diabetes M ellitus Source: McGlynn, et. al., The Quality of Health Care Delivered to Adults in the United States, The New England Journal of Medicine, June 26, 2003:

9 President Bush s Healthcare Legislation Medicare Modernization Act of 2003 (MMA) Mandatory hospital quality reporting Deficit Reduction Act of 2005 (DRA) Fee for Value by % reduction in physician payments by 2014 Tax Relief and Health Care Act of 2006 (TRHCA) Physician Quality Reporting Initiative (PQRI) Medicare Improvements for Patients and Providers of 2008 (MIPPA) erx Incentive Program (Penalties))

10 Baseline Best Medical Practice Quality Measures For Hospitals

11 CMS Quality Initiative for Hospitals The Hawthorne Effect 92% 91% 70% 64% CMS/Premier Hospital Quality Incentive Demonstration

12 Dramatic Improvement in Surgery Related Infections Due to Checklist Measures Instituted by CMS in DR. ATUL GAWANDE on PBS NEWSHOUR: In Michigan, when the -- every hospital there adopted a cleanliness checklist to keep infected lines from happening, they had a two-thirds reduction in infections within a year. They saved more than 1,500 lives and more than $200 million. Spreading this across the country multiplies that by 50-fold. See the video and complete transcript here:

13 CMS Hospital Quality Initiative From Voluntary to Mandatory Reporting Number of Reporting Hospitals Mandatory 0.4% payment deduction Mandatory 2% payment deduction Oct Feb May 2004 Oct Mar Oct

14 2006 Physician Quality Reporting Initiative (PQRI) Number of 100 Quality 80 Measures Voluntary 2% 1.5 %

15 Reporting Methods PQRI Registry Based Reporting Claim Based Reporting Group Measure Reporting Individual Measures Reporting

16 PQRI Bonuses and Penalties Year Bonus Penalty % % % % 2016 and forward - 2%

17 2009 Medicare E-Prescribing Year Bonus for Adopting Penalty for Not Adopting % % % -1% % -1.5% %

18 PQRI and E-Prescribing Initiatives Are Getting Easier to Complete PQRI Requirement 30 Consecutive Encounters PQRI Requirement 30 Non-consecutive Encounters erx Requirement 50% of Prescriptions erx Requirement 25 Prescriptions

19 Carrots and Sticks PQRI Bonus 2% in 2009 PQRI Penalty 2012 eprescribing Bonus eprescribing Penalty 2% in ARRA ARRA Medicare Payments and $44,000 Medicaid for Payments $44,000-$63,750 $63 0 for ARRA Medicare Penalty 2015

20 Meaningful Use

21 $50,000,000,000+,, Of ARRA* Funding To Revolutionize Healthcare I.T. Sections Sections 4101, 4102, 4201 Section 6001 and Titles I, XII Entitlements Grants $42 Billion $10 Billion For Healthcare Providers and Hospitals For HIEs, Rural Broadband, Regional Extension Centers, Education and Training i *Title IV Health Information Technology for Economic and Clinical Health Act (HITECH)

22 ELIGIBLE Professionals for Medicare or Medicaid id EMR Funding of $44,000 to $63,750 Physicians P titi - MD/DO - Podiatrist - Optometrist t t - Oral Surgeon - Dentist - Chiropractor Therapists - Physical Therapist - Occupational Therapist - Qualified Speech- Language Pathologist Practitioners - Physician Assistant - Nurse Practitioner - Clinical Nurse Specialist - Certified Registered Nurse - Anesthetist - Certified Nurse Midwife - Clinical Social Worker - Clinical Psychologist - Registered Dietician - Nutrition Professional - Audiologist ELIGIBLE professionals are defined by the Tax Relief and Health Care Act of 2006.

23 ARRA Section 4101 Up to $44,000 For Medicare Providers and Penalties Assumes a Minimum i of $25,000 of fmedicare Part BPayments Adopt in Adopt in Adopt in Adopt in Failure to Failure to Failure to adopt by adopt by adopt by $18, $12,000 $18, $8,000 $12,000 $15, $4,000 $8,000 $12,000 $12, $2,000 $4,000 $8,000 $8,000-1% $2,000 $4,000 $4, % % Total $44,000 $44,000 $39,000 $24,000-1% -2% -3% Source: Avalere Health LLC

24 Current User Section 4201 Up to $63,750 For Medicaid Providers Assumes a Minimum of 30% of Medicaid or Underprivileged Patients* Adopt in 2011 Adopt in 2012 Adopt in 2013 Adopt in 2014 Adopt in 2015 Adopt in $21,250 $21, $8,500 $8,500 $21, $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $21, $8,500 $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8,500 $8, $8,500 $8,500 $8, $8,500 $8, $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 ** $63,750 ** $63,750 ** $63,750 ** *20% for pediatricians ** Subject to reduction This schedule also applies to eligible professionals in a Federally Qualified Health Center or Rural Clinic. 24

25 Meaningful Use Will Be Determined By Both the Federal Government and the States Examples of Meaningful Use Quality Reporting eprescribing Medication Reconciliation Availability of Lab Results Interoperability Certified by CCHIT* Etc. *Certification Commission for Healthcare Information Technology

26 Automated PQRI Reporting Using the ehealth Made EASY Registry

27 Login Screen

28 Reporting Homepage

29 Reporting Wizard #1

30 Reporting Wizard #2

31 Reporting Wizard #3 List of available codes is calculated relative to the selected QM settings

32 Reporting Wizard #3 Rule Based engine calculates eligible QM for the encounter and patient, leading the provider in coding the PQRI

33 Sample Compliance Report

34 Thank you!