missouri hospital association meaningful use quality measure update

Missouri Hospital Association

Meaningful Use Quality Measure Update

Glass Half Full?

Agenda

• Background

Current state

Stage 1 lessons learned

• Stage 2 Meaningful Use

Hospital/CAH

Eligible Professional (EP)

• Certification

• Looking Ahead

Update On EHR Incentive Programs

• Medicare and Medicaid EHR incentive program registrations:– 3,247 Hospitals– About 188,400 Physicians/EPs

• A growing number, but still small share, have been paid for meeting meaningful use requirements– 712 Hospitals (40 CAH)– 22,937 Physicians

• 43 states have opened Medicaid programs

Data from CMS, as of January 2012

Most, but not all, states have now established Medicaid EHR incentive programs

Red = Made Payments (34); Blue = Accepting Registrations (9)Data from CMS as of January 2012

Cost

In 2010, the average capital IT expense per bed was over $12,000, while the average IT operating expense was over $45,000.

Together, hospitals are spending $57,000 a year per bed on IT.

For a 200-bed hospital, that would translate to over

$11.4 million per year.

The Bottom Line

Stage 1 = Getting it started

Stage 2 = Getting it right

Transition to Automation

Fiscal Year

2012 2013 2014 2015 2016 2017 2018 2019

Inpatient Quality Reporting Program(Pay for reporting)

MB – 2.0If Failure to Report



MB – ¼ of MB If

Failure to Report

MB – ¼ of MB If

Failure to Report

MB – ¼ of MB If

Failure to Report

MB – ¼ of MB If

Failure to Report

MB – ¼ of MB If

Failure to Report

Health Information Technology Meaningful Use (MU)

MB – ¼ of MB

If Failure to Meet

MU

MB – ½ of MB

If Failure to Meet

MU

MB – ¾ of MB

If Failure to Meet

MU

MB – ¾ of MB

If Failure to Meet

MU

MB – ¾ of MB

If Failure to Meet

MU

Problems with Stage 1

Improperly developed e-measure specifications

e-measure



No measure steward

e-measure



No measure steward

No testing

Lack of clinical information

Musts for Stage 2

IQR Automation

IQRAutomation

IQR Automation=

Musts for Stage 2

Hospital sends Data to Vendor

QIO Data

Warehouse

Feedback Reports

Data Submission

Hospital sends Data to Vendor

Vendor Validation

TJC Validation

Validation #1

CMS Requests

Cases

Hospital Sends

Records

CMS Re-Abstracts

Data

Validation #2

Proposed Quality Reporting Requirements for Stage 2 – Linked to National Quality Strategy

34 new measures

15 measures from Stage 1

1. Menu of 49 Measures available for Stage 2

2. Hospitals and CAHs choose 24 measures to report, to include one from

each of six domains

Efficiency(4)

Patient and Family

Engagement (8)

Clinical Processes

(24)

Care Coordina-

tion (2)

Patient Safety

(9)

Population/ Public

Health (2)

Quality Measure Domains

Care Coordination (2)

Stage 2 Proposed Measures for Care Coordination

NQF Number

Measure Title Use in other CMS Quality Programs

0441 Stroke – assessed for rehabilitation IQR

0496 ED – median time from ED arrival to ED departure for discharged ED patients

OQR, MAP


Population/ Public

Health (2)

Stage 2 Proposed Measures for Population and Public Health

NQF Number


1653 Pneumococcal immunization IQR, MAP

1659 Influenza immunization IQR, MAP


Efficiency(4)

Stage 2 Proposed Measures for Efficient Use of Healthcare ResourcesNQF

NumberMeasure Title Use in other CMS

Quality Programs0148 Pneumonia (PN) – blood cultures

performed in the ED prior to initial antibiotic received in hospital

IQR, HVBP, MAP

0147 PN – initial antibiotic selection for community-acquired PN in immunocompetent patients

IQR, HVBP, MAP

0528 SCIP – prophylactic antibiotic selection for surgical patients

IQR, HVBP, MAP

0529 SCIP – prophylactic antibiotics discontinued within 24 hours after surgery end time

IQR, HVBP, MAP


Patient and Family

Engagement (8)

Stage 2 Proposed Measures for Patient and Family EngagementNQF


Quality Programs

0495 Emergency Department (ED) Throughput – Median time from ED arrival to ED departure for admitted patients

IQR, Stage 1 MU

0497 ED Throughput – admit decision time to ED departure time for admitted patients

IQR, Stage 1 MU

0440 Stroke – education IQR, Stage 1 MU0375 Venous Thromboembolism (VTE) –

discharge instructionsIQR, Stage 1 MU


Patient and Family

Engagement (8)

Stage 2 Proposed Measures for Patient and Family Engagement

NQF Number


0136 Heart Failure (HF) – discharge instructions

IQR, HVBP

0338 Home management plan of care document given to patient/caregiver

MAP

0341 Pediatric Intensive Care Unit (ICU) – pain assessment on admission

MAP

0342 Pediatric ICU – periodic pain assessment

MAP


Patient Safety(9)

Stage 2 Proposed Measures for Patient SafetyNQF


Quality Programs0371 VTE – prophylaxis IQR, Stage 1 MU0372 VTE – ICU prophylaxis IQR, Stage 1 MU0375 VTE – incidence of potentially

preventable VTEIQR, Stage 1 MU

0527 Surgical Care Improvement Project (SCIP) – prophylactic antibiotic received one hour prior to surgical incision

IQR, HVBP, MAP

0301 SCIP – surgery patients with appropriate hair removal

IQR


Patient Safety(9)

Stage 2 Proposed Measures for Patient Safety

NQF Number


0453 SCIP – urinary catheter removed on postoperative day one or postoperative day 2 with day of surgery being day zero

IQR, MAP

0434 Stroke – VTE prophylaxis IQR, MAP

0218 SCIP – surgery patients who received appropriate VTE prophylaxis with 24 hours prior to surgery to 24 hours after surgery end time

IQR, HVBP, MAP

0716 Healthy term newborn MAP


Clinical Processes (24)

Stage 2 Proposed Measures for Clinical Processes/EffectivenessNQF


Quality Programs0435 Stroke – discharge on anti-thrombotic

therapy at hospital dischargeIQR, Stage 1 MU

0436 Stroke – anticoagulation therapy for atrial fibrillation/flutter

IQR, Stage 1 MU

0437 Stroke – thrombolytic therapy IQR, Stage 1 MU0438 Stroke – antithrombotic therapy by end

of hospital day twoIQR, Stage 1 MU

0439 Stroke – discharged on statin medication

IQR, Stage 1 MU

0373 VTE – patients with overlap of anticoagulation therapy

IQR, Stage 1 MU





Quality Programs0374 VTE – patients unfractionated heparin

dosages/platelet count monitoring by protocol receiving dosages/platelet count monitored by protocol

IQR, Stage 1 MU

0132 Acute Myocardial Infarction (AMI) – aspirin at arrival

IQR

0142 AMI – aspirin prescribed at discharge IQR, MAP0469 Elective delivery prior to 39 completed

weeks gestationMAP

0137 AMI – ACE/ARB for left ventricular systolic dysfunction

IQR





Quality Programs0160 AMI – beta blocker prescribed at

dischargeIQR

0164 AMI – fibrinolytic therapy received within 30 minutes of hospital arrival

IQR, HVBP, MAP

0163 AMI – primary percutaneous coronary intervention

IQR, HVBP, MAP

0639 AMI – statin prescribed at discharge IQR, MAP0300 SCIP – cardiac patients with controlled

6 AM postoperative serum glucoseIQR, HVBP, MAP





Quality Programs0284 SCIP – surgery patients on a beta

blocker therapy prior to admission who received a beta blocker during the perioperative period

IQR, HVBP, MAP

0480 Exclusive breastfeeding at hospital discharge

N/A

0481 First temperature measured within one hour of admission of the neonatal ICU

N/A

0482 First neonatal ICU temperature less than 36 degrees Celsius

N/A

0143 Use of relievers for inpatient asthma MAP0144 Use of systemic corticosteroids for

inpatient asthmaMAP

0484 Proportion of infants 22 to 29 weeks gestation treated with surfactant who are treated within 2 hours of birth

MAP

1354 Hearing screening prior to hospital discharge

MAP

Quality Measurement Domain Framework

Efficiency(4)

Patient and Family Engagement (8)


Care Coordination (2)

Patient Safety(9)

Population/ Public Health (2)X

X

Measurement

CHOICE

Quality Measurement Domain Framework

Measure Submission

• Sampling of patients to populate quality measures

– Short-term

– Long-term

• Minimum case count

Proposed Quality Reporting Requirements for EPs for Stage 2CMS seeks comments on three options:

Option 1A – Report 12 measures from a menu set of 125 measures, with at least one measure in each of 6 domains

Option 1b – Report 11 “core” measures and choose 1 from the menu of 125 measures

Option 2 – Choose 3 quality measures to report under the Physician Quality Reporting System (PQRS) for EHRs

Option 1a – Linked to National Quality Strategy

83 new measures

42 measures from Stage 1

1. Menu of 125 Measures available for Stage 2

2. EPs must choose 12 measures to report, with at least one from each of

six domains

Efficiency

Patient and Family

Engagement

Clinical Processes

Care Coordina-

tion

Patient Safety

Population/ Public Health

Option 1b – 11 core measures plus 1 choice

Choose 1 from menu of 125 measures available for Stage 2

Report 11 “core” measures1. Closing the referral loop2. Functional status assessment for

complex chronic conditions3. Controlling high blood pressure4. Medication reconciliation5. Screening for clinical depressing6. Tobacco use screening and cessation7. Cholesterol screening8. Use of aspirin/antithrombotic for

Ischemic Vascular Disease9. Weight assessment and counseling of

children10. Use of high-risk medications in the

elderly11. Adverse drug event prevention

Certification Overview

Certification distorts the EHR market and raises costs.

Requiring health care providers to purchase certified products (or certify their self-developed systems) fundamentally changes the market dynamics in favor of the vendor.

Certification Round #1

CMS proposes 49 measures for hospitals and 125 measures for

EPs

Vendors must demonstrate a single CQM can be calculated

CMS requires one measure from six different quality domains


CMS proposes submission of patient-level or aggregate CQM

data

EHRs are not required to calculate CQMs in any specific format


QUALITYDATA

MODEL

Glass Half Full?

What Next?

HIT Efforts

MeasureApplicationPartnership

CQM Process Mapping

Measure previously specified

Measure Authoring Tool (MAT)

New Specification

Medical Record

Abstraction Spec

e-MeasureSpec

CQM Process Mapping


Measure previously specified

New Specification

Medical Record

Abstraction Spec

e-MeasureSpec

Quality Data Model(QDM)

Hospitals EHRVendors

CQM Process Mapping


Quality Data Model(QDM)

Hospitals EHRVendors

Where is the

measure developer?

X e-Measure Developer

IPPS Proposed Rule

MeasureApplicationPartnership

HACsXX X

Resources

• AHA Member Materials on Meaningful Use

http://www.aha.org/meaningfuluse• Office of Civil Rights – HIPAA resources

http://www.hhs.gov/ocr/privacy

• Office of the National Coordinator for HIT - Certification program

http://healthit.hhs.gov/portal/server.pt?open=512&objID=1153&mode=2

• Centers for Medicare and Medicaid Services – Medicare and Medicaid EHR Incentive Programs

http://www.cms.gov/EHRIncentivePrograms

http://www.aha.org/meaningfuluse

http://www.hhs.gov/ocr/privacy



http://www.cms.gov/EHRIncentivePrograms

Missouri Hospital Association

Meaningful Use Quality Measure Update

missouri hospital association meaningful use quality measure update

Documents

reportmb of mb

incentive payments

medicaid programs data

ehr incentive programsmedicare

medicaid eps

physicians43 states

pilot programs

percent of hospitals