Transcript Document

S2MU Part II:
Choosing wisely among
Menu Requirements and
Clinical Quality Measures
Moderator:
Mary Zile, BSN, MHSA
Speakers:
Andrew Bledsoe, MBA
Nathan Diller, MBA, MHSA
REC support is. provided under cooperative agreement
REC support is. provided under cooperative agreement 90RC0025/01 from
90RC0025/01 from the Office of the National
the Office of the National Coordinator for HIT, US Dept. of Health and
Coordinator for HIT, US Dept. of Health and Human
Human Services
Services
Agenda
• Overview of Meaningful Use
• Deep Dive: S2MU Menu Measures
• Deep Dive: Clinical Quality Measures
• Question & Answers
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
2
Overview of Meaningful Use
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Definition of Meaningful Use
• Use of ONC-HIT Certified Electronic Health
Records (EHR)
• Electronic Exchange of Health Information
• Quality Reporting
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
4
HITECH: Policy Framework
Better care for individuals, better health for populations, and lower per-capita costs.
IHI-Triple Aim Initiative
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Pillars of Meaningful Use
Improve quality, safety, efficiency, and reduce health disparities
•
•
•
•
Provide access to comprehensive patient health data for patient’s health care
team
Use evidence-based order sets and CPOE
Apply clinical decision support at the point of care
Generate lists of patients who need care and use them to reach out to patients
Engage patients and families
•
Provide patients and families with timely access to data, knowledge, and tools to
make informed decisions and to manage their health
Improve care coordination
•
Exchange meaningful clinical information among professional health care team
Improve population and public health
•
Submit immunization, syndromic surveillance and reportable disease data to
public health agencies
Ensure privacy and security protection for personal health information
•
•
Protect confidential information through operating policies, procedures, and
technologies
Provide transparency of data sharing to patient
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
7
Why S2MU Matters
• Stage 2 Meaningful Use serves as a foundation for
other health care innovation initiatives
• S2MU is a glide path to:
• Accountable care organizations
• Medical home
• Payment reform initiatives
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
8
Stages of Meaningful
Use
http://www.cms.gov/EHRIncentivePrograms
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
10
For Medicare Hospitals:
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
11
Medicare Payment Adjustments
Medicare EPs who are not
meaningful users will be subject
to a payment adjustment
beginning on January 1, 2015.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
12
Medicare Payment Adjustments
EPs who first demonstrated meaningful use in
2011 or 2012 must demonstrate meaningful use
for a full year in 2013 to avoid payment
adjustments in 2015. They must continue to
demonstrate meaningful use every year to avoid
payment adjustments in subsequent years.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
13
Hardship Exceptions for Medicare
EPs
EPs can apply for hardship exceptions in the following
categories:
• Infrastructure
• New EPs
• Unforeseen circumstances
• By specialist/provider type
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
14
Meaningful Use – Who is eligible for incentives?
Eligible Providers in
Medicare
Eligible Providers in
Medicaid
Eligible Professionals (EPs)
Doctor of Medicine or
Osteopathy
Doctor of Dental Surgery or
Dental Medicine
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Eligible Professionals (EPs)
Physicians (Pediatricians have
special eligibility & payment rules)
Nurse Practitioners (NPs)
Eligible Hospitals
Acute Care Hospitals
Critical Access Hospitals (CAHs)
Eligible Hospitals
Acute Care Hospitals
Children’s Hospitals
Certified Nurse-Midwives (CNMs)
Dentists
Physician Assistants (PAs) who
practice in a Federally Qualified
Health Center (FQHC) or rural
health clinic (RHC) that is led by a
PA
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
No Changes
from Stage 1
Meaningful
Use
S2MU Change in Total Objectives
Required
Stage 1 MU – Eligible Professionals
Stage 2 MU – Eligible Providers
15 core objectives
17 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
20 total objectives
20 total objectives
Stage 1 MU – Eligible Hospitals &
CAHs
Stage 2 MU – Eligible Hospitals &
CAHs
14 core objectives
16 core objectives
5 of 10 menu objectives
3 of 6 menu objectives
19 total objectives
19 total objectives
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
16
How to Get to S2MU
17 Core
Objectives
3 of 6 Menu
Objectives
9 Clinical
Quality
Measures
Meaningful Use
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
17
Deep Dive: S2MU Menu Measures
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
18
Stage 2 MU EP Menu Objectives
Menu Objective
Measure
1. Imaging Results
More than 20% of imaging results are accessible through
Certified EHR Technology
2. Family History
Record family health history for more than 20% of unique
patients
3. Syndromic
Surveillance
Successful ongoing transmission of syndromic surveillance data
4. Cancer
Successful ongoing transmission of cancer case information
5. Specialized
Registry
Successful ongoing transmission of data to a specialized
registry
6. Progress Notes
Enter an electronic progress note for more than 30% of unique
patients
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
EP Menu Set Requirements
Objective
Imaging results
consisting of the
image itself and
any explanation or
other
accompanying
information are
accessible through
CEHRT
Stage 1 MU
N/A
Stage 2 MU
More than 10% of all tests
whose result is one or
more images ordered by
an EP during the EHR
reporting period are
accessible through
CEHRT.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
20
EP Menu Set Requirements
Objective
Record patient
family health history
as structured data
Stage 1 MU
N/A
Stage 2 MU
More than 20% of all
unique patients seen by
the EP during the EHR
reporting period have a
structured data entry for
one or more first-degree
relatives.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
21
EP Menu Set Requirements
Objective
Record electronic
notes in patient
records
Stage 1 MU
N/A
Stage 2 MU
Enter at least one
electronic progress note
created, edited and signed
by an EP for more than
30% of unique patients
with at least one visit
during the EHR reporting
period. Electronic progress
notes must be textsearchable.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
22
EP Menu Set Requirements
Objective
Capability to submit
electronic
syndromic
surveillance data to
public health
agencies, except
where prohibited,
and in accordance
with applicable law
and practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of electronic
syndromic surveillance
data from CEHRT to a
public health agency for
the entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
23
EP Menu Set Requirements
Objective
Capability to
identify and report
cancer cases to a
State cancer
registry, except
where prohibited,
and in accordance
with applicable law
and practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of cancer case
information from CEHRT
to a public health central
cancer registry for the
entire EHR reporting
period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
24
EP Menu Set Requirements
Objective
Capability to
identify and report
specific cases to a
specialized registry
(other than a
cancer registry),
except where
prohibited, and in
accordance with
applicable law and
practice
Stage 1 MU
N/A
Stage 2 MU
Successful ongoing
submission of specific
case information from
CEHRT to a specialized
registry for the entire EHR
reporting period.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Summary of
Change
New
Requirement
25
Deep Dive: Clinical Quality Measures
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
26
Domains
Patient and Family Engagement
Patient Safety
Care Coordination
Population/Public Health
Efficient Use of Healthcare Resources
Clinical Process/Effectiveness
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
27
How do CQMs relate to the CMS
Incentive Programs?
Although reporting CQMs is no longer a core objective
of the EHR Incentive Programs, all providers are
required to report on CQMs in order to demonstrate
Meaningful Use.
In 2014 and beyond, reporting programs (i.e., PQRS,
eRx reporting) will be streamlined in order to reduce
provider burden.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Alignment Among Programs
2014 represents
CMS’s commitment to
aligning quality
measurement and
reporting among
programs, including
Hospital Inpatient
Quality Reporting
Program, PQRS,
CHIPRA, and ACO
Programs.
Hospital
Inpatient
Quality
Reporting
Program
ACO
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
PQRS
CHIPRA
Reporting CQMs in 2014 and Beyond
Beginning in 2014, all Medicare-eligible providers in their
second year and beyond of demonstrating meaningful
use must electronically report their CQM data to CMS.
Medicaid providers will electronically report their CQM
data to their state.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Clinical Quality Measures
Provider
Prior to 2014
Complete 6 out of 44:
EPs
3 core or 3 alt. core
+
3 menu
Eligible Hospitals
Complete 15 out of 15
and CAHs
2014 and Beyond*
Complete 9 out of 64
Must cover at least 3 NQS domains
Recommended core CQMs include:
9 CQMs for the adult population
9 CQMs for the pediatric population
Prioritize NQS domains
Complete 16 out of 29
Choose at least 1 measure in 3 NQS
domains
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
Please note:
• In 2014, providers will only demonstrate Meaningful
Use for a three-month period
• EP’s – Calendar Year
• EH’s – Fiscal Year
(Medicare Providers three month period must be tied to quarter)
• All subsequent reporting period will be entire year
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
32
Reporting Options for EP’s – 2014 and After
Category
Data Level
Payer Level
Submission
Type
Reporting Schema
EP’s in First Year of MU
Aggregate
All Payer
Attestation
Submit 9 CQM’s covering 3
Domains
EP’s Beyond the First Year of Demonstrating Meaningful Use
Option 1
Aggregate
All Payer
Electronic
Submit 9 CQM’s covering 3
Domains
Option 2
Patient
Medicare Only
Electronic
Satisfy Requirements of
PQRS using CEHRT
Group Reporting (Only EP’s Beyond the First Year of Demonstrating Meaningful Use)
EP’s in an ACO
(Medicare Shared
Savings Program or
Pioneer ACO’s
Patient
Medicare Only
Electronic
Satisfy Requirements of
ACO
EP’s Satisfactorily
Reporting via PQRS
Group Reporting
Options
Patient
Medicare Only
Electronic
Satisfy Requirements of
PQRS Group reporting
using CEHRT
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
33
Recommended Core CQM’s
For both adult and pediatric providers, CMS is
recommending certain core CQM’s for providers
These recommendations were based on the following:
• Conditions contributing to morbidity and mortality
• Conditions representing national public health priorities
• Conditions common to health disparities
• Conditions driving healthcare costs
• Measures allowing agencies to more effectively measure quality care
• Measures that include patient and/or caregiver engagement
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
34
Recommended Core CQM’s
Adult Recommended Core Measures
NQF: 018 Controlling High Blood Pressure
NQF: 022 Use of High-Risk Medications in the Elderly
NQF: 028 Preventative Care and Screening: Tobacco Use: Screening and Cessation Intervention
NQF: 052 Use of Imaging Studies for Low Back Pain
NQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-Up
NQF: 419 Documentation of Current Medications in the Medical Record
NQF: 421 Preventative Care and Screen: Body Mass Index Screening and Follow-Up
NQF: TBD Closing the Referral Loop: Receipt of Specialist Report
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
35
Recommended Core CQM’s
Pediatric Recommended Core Measures
NQF: 002 Appropriate Testing for Children and Pharyngitis
NQF: 024 Weight Assessment and Counseling for Nutrition and Physical Activity
NQF: 033 Chlamydia Screening for Women
NQF: 038 Childhood Immunization Status
NQF: 069 Appropriate Treatment for Children with Upper Respiratory Infection
NQF: 108 ADHD: Follow-Up Care for Children Prescribed ADHD Medication
NQF: 418 Preventative Care and Screening: Screening for Clinical Depression and Follow-Up
NQF: TBD Children Who Have Dental Decay or Cavities
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
36
CQM By Specialty
The CQM’s can be grouped by the following areas:
• Asthma - 1
• Cancer Screening and Oncology Measures – 7
• Cardiovascular Care Measures – 11
• Coordination of Care Measures – 1
• Family Medicine Measures – 15
• Dental Care Measures – 2
• Diabetes Measures – 8
• Measures for Elderly Patients – 4
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
37
CQM By Specialty
•
•
•
•
•
•
•
•
•
•
Functional Status Measures – 3
Imaging Measures 2
Infectious Disease Measures – 7
Mental Health and Substance Abuse Measures – 13
Pediatric Measures – 9
Prenatal Measures – 2
Preventative Care Measures – 16
Vaccination Measures – 3
Vision Care Measures – 6
Women’s Health Measures – 5
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
38
Reporting Specifications
Each eCQM can be described in 3 different ways
depending on the intended use:
HTML - This is a human readable format so that the
user can understand both how the elements are
defined and the underlying logic used to calculate the
measure.
XML – This is a computer readable format which enables
the automated creation of queries against an EHR or
other operational data store for quality reporting.
Value Sets – Value sets are the specific codes used by
developers to program the system to accurately
capture patient data in the EHR system.
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
39
Q&A Session
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
40
Additional MU Information
Tri-State Regional Extension Center
www.tristaterec.org/S2MU
CMS EHR Incentive Program Home Page
http://www.cms.gov/EHRIncentivePrograms/
Office of National Coordinator for Health IT
http://healthit.gov/
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
41
References / Resources
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/2014_Cl
inicalQualityMeasures.html
http://www.healthit.gov/providers-professionals/howattain-meaningful-use
http://www.cms.gov/apps/ama/license.asp?file=/QualityM
easures/Downloads/EP_MeasureSpecifications.zip
http://motorcycleguy.blogspot.com/2012/11/hashtagsoup-relating-qdm-hqmf.html
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
References / Resources
http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Electroni
c_Reporting_Spec.html
REC support is. provided under cooperative agreement
90RC0025/01 from the Office of the National
Coordinator for HIT, US Dept. of Health and Human
Services
43