Measuring & Monitoring Clinical Quality Measures Using Practice Fusion

Editor's Notes

• #3: WHAT ARE CLINICAL QUALITY MEASURES? Clinical quality measures, also called CQMs, are tools that help us measure and monitor the quality of healthcare and the contribution of those healthcare services towards improved health outcomes. In the past, quality measures primarily used data that came from claims, but as technology has improved and become more prominent in the healthcare setting, many quality measures now use data that comes from a provider’s electronic health record (EHR). These electronic CQMs (eCQMs) use EHR data to measure health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagement, and population and public health improvement.
• #4: There are a lot of terms used when discussing and understanding quality measures. The definitions below will help you better use this guide to measure and monitor the quality of care that you provide to your patients. Denominator – The population of patients or encounters for which the measure applies. Numerator - The population of patients from the denominator who meet the measure specified clinical requirements or the population of encounters from the denominator where the measure specific requirement has been performed. Exclusion/Exception – Specifications that would remove a patient from the denominator of a specific quality measure. These exclusions and exceptions include certain diagnoses that make it clinically unnecessary for the patient to receive the numerator clinical action and/or provider or patient determined reasons for refusing certain clinical actions. Measurement period – This is also known as the EHR reporting period and refers to the time frame for which the CQMs will be calculated. For more information on determining your CQM reporting period, refer to the reporting requirements at the end of this guide.
• #5: National Quality Strategy (NQS) Domains – The National Quality Strategyoutlines the federal plan to improve the quality of healthcare delivered in the United States and was developed as a result of the Affordable Care Act. The six NQS domains, one of which is assigned to each CMS eCQM, are: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, and Clinical Processes/Effectiveness. Information on what NQS domain applies to which measure is available in the Practice Fusion CQM report and in the Practice Fusion CQM Calculation Guide. National Quality Forum (NQF) – The National Quality Forum reviews, endorses, and recommends use of standardized quality measures. Not all quality measures are “NQF-endorsed,” but those that are have an assigned NQF number. Value sets - Lists of specific values (terms and their codes) derived from single or multiple standard vocabularies used to define clinical concepts (e.g. patients with diabetes, clinical visit, reportable diseases) used in clinical quality measures and to support effective health information exchange. Although there are many uses for value sets, a primary purpose of the value sets is to support the 2014 Clinical Quality Measures prescribed for Meaningful Use. Most of the value sets are therefore used to define the patient populations that should be included in the denominators and in the numerators when computing a clinical quality measure.Quality Reporting Document Architecture (QRDA) – An HL7-based standard document format for the exchange of clinical quality measure data. QRDA reports contain data extracted from electronic health records (EHRs) and other information technology systems. QRDA reports are used for the exchange of CQM data between systems for a variety of quality measurement and reporting initiatives, including Meaningful Use and PQRS. These programs require the submission of QRDA Category I reports, which utilize patient-level data, or QRDA Category III reports, which utilize aggregated patient data.
• #6: The current set of CMS electronic clinical quality measures that can be used for Meaningful Use are much more complex than the quality measures used for the MU program in previous years. The measures included as part of 2014 EHR certification underwent an extensive quality measurement development process that included reviewing evidence, creating the specifications for the patient population and clinical numerator, testing the measure, defining out the data needs to be collected and defined, and going through the national measure endorsement process (usually through the National Quality Forum). The measure specifications that are given to EHR vendors like Practice Fusion include the exact coded values that make up value sets, information on which value sets make up the criteria for the numerator and the denominator, and which value sets are used in creating the measure logic. Because each quality measure has defined value sets that can be used, each measure has very specific data elements that patients must have in their medical record for the denominator and very specific, although sometimes a large set of options, that you as the provider can enter in the EHR in order to receive credit in the numerator. Although it may seem like a checkbox is the easiest option, checkboxes prevent you from recording the care you have provided in a specific and accurate way. As you all know, not all tobacco cessation interventions are the same – because you can now enter in a variety of potential options for indicating that your patients have received a cessation intervention, your medical records – and your patients’ medical records – will not reflect that care more accurately.
• #7: Measuring and monitoring your performance on clinical quality measures is only part of the picture. Reporting clinical quality measures to appropriate organizations is a big part of moving the health care industry away from fee-for-service and towards pay-for-value. For many providers, clinical quality measure reporting comes as part of participating in the Meaningful Use program and/or the Physician Quality Reporting System, or PQRS. These programs are designed to ease providers into the processes of measuring, monitoring, and reporting quality related data to CMS in order to help them track the performance of physicians who are reimbursed under Medicare. Over time, this data will be used to determine reimbursement values. For the purposes of both Meaningful Use and PQRS, it is important to note that there are no percentage thresholds required for participation and reporting, although for PQRS providers must have values in the denominator of the measures they are reporting. For both MU and PQRS, providers have multiple reporting mechanism options that they can choose from depending on their preferences and whether the measures they want to report are supported in Practice Fusion. Today’s webinar will focus more heavily on Meaningful Use CQM reporting, but will touch a bit on PQRS reporting as it pertains to the CQMs that Practice Fusion supports.
• #8: The CQM reporting requirement for Meaningful Use is to report at least 9 measures that cover at least 3 of the National Quality Strategy domains. Under the 2014 Medicare Physician Fee Schedule Final Rule, CMS made some changes to the rules that govern how providers will need to report CQMs for Meaningful Use. There are now two different reporting options available to providers participating in Meaningful Use. The first reporting option is to manually submit CQM values during attestation to CMS. This is a similar process to how CQM values were submitted to CMS in prior years. When you submit CQM data during attestation, you will need to type in the values from the CQM report exactly as they appear in the EHR at the end of your 90-day period. Zero values are acceptable if you do not have 9 CQMs in your Practice Fusion Clinical Quality Measures report with values in the denominator or numerator. Submitting zero values will not prevent you from achieving Meaningful Use and receiving an incentive payment. The second reporting options is electronic reporting of CQMs to CMS. The reporting period for electronic submission of CQM data will be a full calendar year, from January 1st to December 31st of 2014. Practice Fusion will submit CQM data to CMS at the end of the CQM measurement period for providers who choose the EHR reporting mechanism to report CQMs to CMS for the purposes of Meaningful Use. CQM data will be electronically submitted to CMS as a file that meets the HL7 standards for the Quality Reporting Data Architecture (QRDA). Providers who choose the electronic reporting mechanism for Meaningful Use will have their attestation incentive payments delayed until their CQM values have been reported, but those providers can get credit for both MU and PQRS via this one submission, as long as the measures they are reporting meet the PQRS requirement of having values in the denominator and include data for at least one Medicare patient. Practice Fusion will begin accepting requests for providers who wish to have CQM data submitted to CMS in the fall of 2014. We recommend that providers manually attest to CQM values so that MU payments aren’t delayed, but also continue to monitor the full calendar year reporting period for PQRS.
• #9: As in past years, PQRS offers multiple reporting mechanisms: claims, registry, or direct EHR. Practice Fusion will now support electronic reporting for PQRS measures starting this year. Providers who wish to report PQRS via their EHR will be required to report 9 measures covering at least 3 of the National Quality Strategy domains using a certified EHR system that has been certified to the most recent version of the CMS electronic CQMs. Practice Fusion’s CQMs are all certified to the most recent version of the measure specifications. In order to use the EHR reporting option for PQRS, a provider must report on at least 1 measure for which there is Medicare patient data. As in past years, measures with a zero value denominator cannot be used for PQRS. The PQRS measurement period length is a full calendar year, so for 2014 it would run from January 1, 2014 through December 31, 2014.Providers who submit CQMs via Meaningful Use attestation can still use electronic submission with Practice Fusion for the purposes of 2014 PQRS reporting in January 2015.Practice Fusion will begin accepting requests for providers who wish to have CQM data submitted to CMS for the purposes of PQRS in the fall of 2014. For additional information on PQRS reporting in 2014, including information on the alternative reporting mechanisms such as claims-based reporting, please sign up to attend the “Understanding PQRS in 2014” webinar, scheduled for Tuesday, February 4th at 12pm Eastern/9am Pacific. A link to register for this event will be sent via email to all attendees of this webinar after today’s presentation.
• #10: Now that we’ve completed an overview of the CQM requirements for Meaningful Use and PQRS, let’s spend some time diving deeper into each of the 13 quality measures that Practice Fusion currently offers, including the measure specifications and how the data used in the measure calculation is collected in Practice Fusion. For some the measures where we have gotten a lot of questions, we will take a look at where in the EHR to input the data. This presentation contains suggested workflow information and examples of data entry that may receive credit for individual CQM calculations. These suggestions and examples are not intended to represent all eligible workflows for meeting the measure criteria. Before we begin, I’d like to note that Practice Fusion does plan to support additional Meaningful Use and PQRS quality measures in the near future, so if you are interested in measuring and monitoring other CMS quality measures that are not available in Practice Fusion right now, you will start to see us add more data elements to the EHR in the near future and the calculations added for those measures sometime during the middle of 2014. Now, let’s get started with the first measure, Controlling High Blood Pressure.
• #18: CMS has created the 2014 electronic clinical quality measures (eCQMs) to have more rigorous data collection requirements than previous Meaningful Use quality measures. As such, there are some limitations in how Practice Fusion can collect data for purposes of CQM calculations and reporting. An example of this is that CMS requires an actual lab result when a measure requires a performed FOBTtest (or result). While we are working with our lab partners to increase how many send structured LOINC codes to identify these tests, we are also working with those lab partners to map and identify test results that come in with local laboratory codes so that we can properly give credit when we are able to.
• #28: Many of our customers have asked us about whether screenings that are suggested using clinical decision support are required for some specialties. If you are a specialist that doesn’t conduct depression screenings, you may see your denominator increase but not your numerator. This is perfectly acceptable as it is a known fact that not all specialties will conduct all preventative screenings. Since zero values are acceptable for MU, this will not prevent you from attesting successfully. If you wish, you can turn off the CDS alerts for depression screening in the clinical decision support settings section of the EHR, but make sure you have the minimum amount of alerts enabled as needed for your stage of MU.