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EHR Incentives for
Professionals and
Hospitals
Paul Forlenza, VP Policy, VITL
updated October 1, 2010 – v.8.1
Disclaimer
• Not legal analysis or advice
• Analysis based on reviewing Centers for
Medicare and Medicaid Services (CMS) Final
Rule (800+ pages) and analysis by other
health care policy organizations
Contact: Paul Forlenza, VP Policy
Vermont Information Technology Leaders, Inc.
802-223-4100 x103 [email protected]
10/1/2010 2VITL - V.8.1
Topics
• Health Outcome Priorities
• Stages for Implementing Meaningful Use
• Eligible Professionals
– Eligibility
– Requirements to Achieve Meaningful Use
– Clinical Quality Measures
– Medicare and Medicaid Incentive Payments
– Timeline and Next Steps
• Eligible Hospitals
• Appendix - Details about MU subjects
10/1/2010 3VITL - V.8.1
10/1/2010 4VITL - V.8.1
EHR INCENTIVES FOR PROFESSIONALS
Health Outcome Priorities
1. Improve quality, safety, efficiency
and reduce health disparities
2. Engage patients and families in
their health care
3. Improve Care Coordination
5. Improve population and public
health
4. Protect privacy and security of
personal health information
10/1/2010 5VITL - V.8.1
Which program am I eligible for?
Medicare
• Doctors (PFS *):
– Medicine and Osteopathy
– Dental Surgery or Medicine
– Doctor of Podiatric
Medicine
– Doctor of Optometry
– Chiropractors
• Incentive for practicing in a Health Professional Shortage Area (10%)
Medicaid
• Patient Volume
Thresholds
– Physicians
– Pediatricians
– Nurse practitioners
– Certified Nurse Midwives
– Physician Assistants at
FQHC/RHC led by PA
– Dentists
* Physician Fee Schedule
10/1/2010 6VITL - V.8.1
Who is not eligible for incentives?
• Professionals that perform substantially (90%)
all of their services in an inpatient hospital
setting or emergency room are not eligible
Eligible? ProfessionalsPlace of Service
Codes
NO
Hospitalists
ER Physicians
Radiologists
Anesthesiologists
POS 21 and 23
YESProfessionals in
outpatient setting POS 22
10/1/2010 7VITL - V.8.1
Do I qualify for
the Medicaid Program?
Eligible Professionals1st YR 90-day
Patient Volume *Comments
Physicians 30%
Pediatricians 20%
Nurse Practitioner 30%
PAs at FQHC/RHC 30%
Certified Nurse
Midwives30%
Dentists 30%
* Second year requires a full year of patient volume
Threshold for
Eligible
Professionals ,
predominantly
practicing in
FQHC/RHC,
must have a 30%
"needy
individual"
patient volume
10/1/2010 8VITL - V.8.1
Patient Volume
• Eligible professional: calculate using patient
encounters or patient panel
• Alternative: use practice/clinic volume
• CMS also allows states to develop alternative
methods to calculate patient volume
10/1/2010 9VITL - V.8.1
Calculating Patient VolumePatient Encounter Method
Total Medicaid patient encounters
in any 90-day period in the
Preceding calendar year
Total patient encounters in
that same 90-day period
x 100 = %
10/1/2010 10VITL - V.8.1
Patient Volume ExamplePatient Encounter Method
100 Medicaid patient encounters
300 Total patient encounters
x 100 = 33%
Physician
qualifies for
Medicaid
Program
10/1/2010 11VITL - V.8.1
Calculating Patient VolumePatient Panel Approach
Total Medicaid patients assigned to EP’s panel in any representative, continuous 90 days in the preceding calendar year
Total patients assigned to a EP in same 90 day period with at least one encounter with patient during year prior to 90 day period
x 100 = %
10/1/2010 12VITL - V.8.1
Stages for implementing
Meaningful Use
Capture data in structured form and limitedsharing
Advanced clinical processes and robust health information exchange
Improved outcomesStage 1:
2011
Stage 2:
2013
Stage 3:
2015
10/1/2010 13VITL - V.8.1
How do I achieve Meaningful Use?
A. Use certified Electronic Health Record
(EHR) in a meaningful manner
B. Electronically exchange health information
to improve quality of care
C. Report Clinical Quality Measures to CMS
10/1/2010 14VITL - V.8.1
What is a certified EHR?
• Previously EHRs certified by Certification
Commission for Health Information
Technology (CCHIT)
• ONC now selecting “Authorized Testing and
Certification Bodies”(9-23-10)
– Certification Commission for HIT (CCHIT)
– Drummond Group, Inc. (DGI)
– InfoGard Laboratories, Inc.
• Certified EHRs to be post on ONC website
10/1/2010 15VITL - V.8.1
A. How do I use a certified EHR
in a meaningful manner?
• EPs: 15 Core Objectives (EHs: 14)
– use certain functions of EHR like e-Prescribing
– maintain active problem lists
– Report clinical quality measures (CQMs)
• EPs and EHs 5 of 10 Menu Set Objectives
– generate lists of patients by specific conditions
– capture clinical lab results in structured format
– Implement drug-formulary checks
10/1/2010 16VITL - V.8.1
B. How do I exchange health
information?
• Must be with an unaffiliated organization
– Connect to the VT Health Information Exchange
– Connect directly (point to point)
• Examples
– Accept lab results as structured data into EHR
– use e-Rx (generate and transmit electronically)
• Robust bi-directional exchange delayed
10/1/2010 17VITL - V.8.1
C. What clinical quality measures
must I report?
• Clinical Quality Measurers based on
PQRI/NQF *
– 3 core CQMs
– Or 3 alternate core
– Plus 3 additional from list of 38 CQMs
*PQRI: Physician Quality Reporting Initiative;
NQF: National Quality Forum
10/1/2010 18VITL - V.8.1
Maximum Medicaid incentives ?1,2
Payment Year Total
Incentive
Payments2011 2012 2013 2014 2015 2016 2017-21
Stage 1
$21,250
Stage 1
$8,500
Stage 2
$8,500
Stage 2
$8,500
Stage 3
$8,500
Stage 3
$8,500$63,750
Stage 1
$21,250
Stage 1
$8,500
Stage 2
$8,500
Stage 3
$8,500
Stage 3
$8,500
Stage 3
$8,500$63,750
Stage 1
$21,500
Stage 2
$8,500
Stage 3
$8,500
Stage 3
$8,500
Stage 3
$8.5k*2$63,750
Stage 1
$21,500
Stage 3
$8,500
Stage 3
$8,500
Stage 3
$8.5k*3$63,750
Stage 3
$21,500
Stage 3
$8,500
Stage 3
$8.5k*4$63,750
1. Flat fee payment based on 85% of EHR “net allowable costs”
2. Max. incentive for Pediatrician, with 20% patient threshold, $42,500
10/1/2010 19VITL - V.8.1
First year A/I/U option for Medicaid
• No EHR prior to Incentive Program
– Adopt (acquired and installed)
– Implement (started use of EHR)
• Existing EHR
– Upgrade (expanded/upgraded to certified EHR
technology or added new functionality)
10/1/2010 20VITL - V.8.1
What are maximum Medicare
incentives?
Payment Year Total
Incentive
Payments2011 2012 2013 2014 2015 2016
Stage 1*
$18,000
Stage 1
$12,000
Stage 2
$8,000
Stage 2
$4,000
Stage 3
$2,000$44,000
Stage 1
$18,000
Stage 1
$12,000
Stage 2
$8,000
Stage 3
$4,000
Stage 3
$2,000$44,000
Stage 1
$15,000
Stage 2
$12,000
Stage 3
$8,000
Stage 3
$4,000$39,000
Stage 1
$12,000
Stage 3
$8,000
Stage 3
$4,000$24,000
Payment Adjustments -1% -2% -3%
1. No Medicare early adoption option
2. Payment based on 75% of PFS
10/1/2010 21VITL - V.8.1
CMS
Menu Set
Measures
Core
Measures
Clinical
Quality
Measures
State
Medicaid
Office
Register using CMS web-based portal.
Single, annual, consolidated payment.
Tied to NPI but can be transferred to
practice/clinic.
Medicaid
2011 Adopt/Implement/Upgrade
2012 Attest; report 90 days data
2013 Attest; report data for 1 yr
Medicare
2011 Attest to MU & report
aggregate data for 90 days
2012 Attest & report for 1 year
10/1/2010 22VITL - V.8.1
How do I get my Medicare/Medicaid
incentive payments?
Other Considerations for EPs
• Medicare or Medicaid; not both; switch once
• Meaningful use for professional; not practice
• Calculate thresholds by provider or practice
• FQHC/RHC “Needy Individuals” threshold
– Medicaid patients
– Uncompensated care
– No cost or sliding scale fee patients
– Children Health Insurance Program (CHIP) enrollees
10/1/2010 23VITL - V.8.1
38 Clinical
Quality
Measures
CMS or
State
10 Menu Set
Objectives
15 Core
Objectives
Stage 1: Reporting Requirements
or 3 alternate
1 must be
public health
measure
State can move 4
public health
measures from
menu to core
Hypertension
Tobacco use
Adult weight
Alternate: Children Weight
Flu Immunization > 50 yrs
Children Immunization
10/1/2010 24VITL - V.8.1
What are the differences between
the EHR Incentive Programs?
Medicare
No patient thresholds
No mid-levels
• $44,000 maximum
• 10% HPSA bonus
• 75% allowable PFS charges
Payments over 5 yrs
( 2011-2016)
Can not skip a year
1st yr must demonstrate
Meaningful Use
Penalties starting 2015
Medicaid
Patient volume thresholds
Mid-levels included
• $63,750 maximum
• based on 85% of EHR
“net allowable costs”
Payments over 6 yrs
(2011-2021)
Can skip a year
Adopt, implement or upgrade
option for 1st yr
No penalties
10/1/2010 25VITL - V.8.1
Timeline for EHR incentives
• Jan. 2011:
– Medicare/Medicaid registration begins
– Earliest date for States to launch program
• April 2011:
– Attestation for Medicare begins
– State sets date for Medicaid attestation
• May 2011: Medicare incentive payments begin
• Feb. 2012: Last day for EPs to register and
attest to receive CY2011incentive payment
10/1/2010 26VITL - V.8.1
CMS Plans for Stage 2
• Add menu set objectives to core set
• Aggressively advance threshold levels
• More robust information exchange
• Increase structured formats
• Add behavioral/mental health objectives
• Re-introduce specialty reporting
10/1/2010 27VITL - V.8.1
What can VITL Offer you?
If you have an EHR:
• Self-assessment tool of metrics
• Assistance in filling any gaps
• Incentive calculation Tool
If you are getting ready to deploy an EHR:
• Full staff education in MU metrics
• Workflow redesign support
• Planning to ensure full compliance
10/1/2010 28VITL - V.8.1
Next steps
• VITL is a Regional HIT Extension Center
(REC) with funding from HHS/ONC to provide
direct assistance to Vermont primary care
providers
– If you have not signed a Direct Services Agreement
(DSA), contact Larry Gilbert [email protected]
– If you have signed a DSA, contact Carol Kulczyk
802-223-4100
10/1/2010 29VITL - V.8.1
Additional VITL Resources
• VITL Summit Presentations vitlsummit.net
• Federal rule and other resources
vitl.net/incentives
• CMS EHR Incentives
cms.gov/EHRIncentivePrograms/
10/1/2010 30VITL - V.8.1
Questions?
Questions
10/1/2010 31VITL - V.8.1
10/1/2010 32VITL - V.8.1
Brattleboro Memorial Hospital
Central Vermont Medical Center
Copley Hospital
Fletcher Allen Health Care
Gifford Medical Center
Grace Cottage Hospital
Mt. Ascutney Hosp. & Health Center
North Country Hospital
Northeastern VT Regional Hospital
Northwestern Medical Center
Porter Hospital
Rutland Regional Medical Center
Southwestern VT Medical Center
Springfield Hospital
EHRHOSPITAL
INCENTIVES
Health Outcome Priorities
10/1/2010 33VITL - V.8.1
1. Improve quality, safety, efficiency
and reduce health disparities
2. Engage patients and families in
their health care
3. Improve Care Coordination
5. Improve population and public
health
4. Protect privacy and security of
personal health information
Eligible Hospitals 1
• Medicare
– Acute Care• 25 beds or less
• CCN 2
– Critical Access
• Medicaid Patient
Thresholds
– Acute Care 10%
– Critical Access 10%
– Cancer 10%
– Children’s none
10/1/2010 34VITL - V.8.1
1.One incentive payment for each CMS Certification Number (CCN)
2. CCN series 0001-0879 and 1300-1399
How do I achieve Meaningful Use?
A. Use certified EHR * in a meaningful
manner
B. Electronically exchange health information
to improve quality of care
C. Report Clinical Quality Measures to CMS
10/1/2010 35VITL - V.8.1
* Certified by ONC Authorized Testing & Certification Body
A. How do I use a certified EHR
in a meaningful manner (EH)?
• Core Objectives (14 of 14)
– CPOE
– maintain active problem lists
– report clinical quality measures (CQMs)
• Menu Set Objectives (5 of 10)
– generate lists of patients by specific conditions
– capture clinical lab results in structured format
– implement drug-formulary checks
10/1/2010 36VITL - V.8.1
B. How do I exchange health
information?
• Electronic exchange with an unaffiliated
organization
– VT Health Information Exchange
– Point to point
• Robust bi-directional exchange delayed until
stage 2 (2013)
C. Clinical quality measures
• 15 of 15 CQMs (PQRI/NQF)
10/1/2010 37VITL - V.8.1
Eligible Hospital Medicare
Incentive
First Payment year
Incentive Payments
# of years
FY2011 FY2011-FY2014
4 yearsFY2012 FY2012-FY2015
FY2013 FY2013-FY2016
FY2014 FY2014-FY2016 3 Years
FY2015 FY2015-FY2016 2 Years
10/1/2010 38VITL - V.8.1
Medicare Hospital Incentives a
Medicare discharges 1,150 –
23,000 b$200 per discharge
Multiple by Transition factor
1st yr: 1.00
2nd yr : .75
3rd yr: .50
4th yr: .25
Multiple by Medicare share of
acute care discharges%
(a) Hospitals are eligible for both Medicaid and Medicare incentives. (b) Discharge limits for yrs 2-4 increased by 3 yr historic growth rate.
$2 million for each year plus $ per discharge
10/1/2010 39VITL - V.8.1
Medicare Incentives - CAHs
• Reasonable costs incurred for the purchase of
depreciable assets, (computers, associated
hardware and software) necessary to
administer certified EHR in cost reporting
period and;
• Any similarly incurred costs from previous
cost reporting periods to the extent they have
not been fully depreciated as of the cost
reporting period involved and … (more)
10/1/2010 40VITL - V.8.1
Medicare Incentives - CAHs
• CAH’s Medicare share equals the Medicare
share as computed for eligible hospitals,
including adjustment for charity care, plus
• 20% points (but not to exceed 100 percent).
• Percentage adjustment used instead of 101%
typically applied to a CAH’s reasonable costs,
• and the incentive payments would be in lieu
of payments that would otherwise be made
………. (more)
10/1/2010 41VITL - V.8.1
Medicare Incentives - CAHs
• Reductions if not Meaningful User FY2015
– FY2015: 101% of reason costs to 100.66%
– FY2016: to 100.33%
– FY2017: and subsequent years to 100%
• Exemption from reduction could be allowed
• May appeal statistical and financial
amounts from the Medicare cost report
10/1/2010 42VITL - V.8.1
Eligible Hospital Medicaid Incentives
• 1st year alternative to Meaningful Use – Adopt, Implement or Upgrade
– Certified EHR by ONC-ATCB*
– Qualifies for 1st year payment
• Reporting Clinical Quality Measurers– 1st year is by attestation
– Report numerator, denominator, exclusion data
– Subsequent years require electronic submission
* ONC Authorized Testing and Certifying Body
10/1/2010 43VITL - V.8.1
Medicaid Hospital Incentives a
$2 million for base year plus $ per discharge
Medicaid discharges
1,150 – 23,000 b$200 per discharge
Multiple by Transition factor1st yr 1.00 2nd yr .75
3rd yr .50 4th yr .25
Multiple by Medicaid share of
acute care discharges%
a. Hospitals eligible for Medicaid and Medicare incentives
b. Discharge limits for yrs 2-4 increased by 3 yr historic growth
(Total EHR Cost) x (Medicaid Share) OR
10/1/2010 44VITL - V.8.1
Eligible Hospital Incentives
Rule
Annual
Preliminary
Payment
Final Payment
Payment
duration
Achieve Meaningful
Use by certain date
Limitations
Payment
Adjustments
Medicaid
State to decide
State to decide
FY2011-FY2021
(3-6 yrs)
No later than
FY2016
May be non-consecutive
1 Yr Payment not > 50%
2 Yr not > 90%
None
10/1/2010 45VITL - V.8.1
Medicare
Based on
prior year
discharges
Based on current yr
FY2011-FY2016
(4 yrs)
FY2013 for
full incentive
Consecutive years
Begin
FY2015
Questions?
Questions
10/1/2010 46VITL - V.8.1
Appendix
Eligible Professional
• Physician Assistance,
FQHC, RHC
• Data Exchange
Requirements
• Core Objectives
• Menu Set Objectives
• Clinical Quality
Measures
Eligible Hospital
• Core Objectives
• Menu Set objectives
• Clinical Quality
Measures
10/1/2010 VITL - V.8.1 47
Physician Assistant at FQHC/RHC
• PA eligible at FQHC/RHC if led by a PA
– PA is primary provider in a clinic
– PA is clinical or medical director at a clinic site
– PA is owner of RHC
• FQHC includes section 330 organizations:
– Community Health Centers, Migrant Health
Centers, Healthcare for the Homeless Programs,
Public Housing Primary Care Programs, Federally
Qualified Health Center Look-Alikes, and Tribal
Health Centers.
10/1/2010 VITL - V.8.1 48
Data Exchange: EP Core Set
1. Provide patients an electronic copy of their
ambulatory, ED or inpatient summary of care
record
2. Transmit prescriptions
3. Capability to exchange key clinical
information among care providers and
patient authorized entities
4. Report clinical quality measures
10/1/2010 49VITL - V.8.1
Data Exchange: EP Menu Set
1. Incorporate clinical lab tests results into
EHRs as structured data
2. Provide summary care record for patients
referred/transition to another provider
3. Capability to submit data to immunization
registries, provide syndromic surveillance and
lab data to public health agencies
10/1/2010 50VITL - V.8.1
Must include at least one public health transaction
EP –15 Core Objectives
1. Computerized physician order entry (CPOE)
2. E-Prescribing (eRx)
3. Report ambulatory clinical quality measures
4. Implement one clinical decision support rule
5. Provide patients with an electronic copy of their
health information, upon request
6. Provide clinical summaries for patient office visit
7. Drug-drug and drug-allergy interaction checks
10/1/2010 51VITL - V.8.1
EP –15 Core Objectives
8. Record demographics
9. Maintain up-to-date problem list
10.Maintain active medication list
11.Maintain active medication allergy list
12.Record and chart changes in vital signs
13.Record smoking status for patients 13 years or older
14.Capability to exchange key clinical information
among providers of care and patient-authorized
entities electronically
15.Protect electronic health information
10/1/2010 52VITL - V.8.1
EP Menu Set ObjectivesStage 1: pick 5 of 10
1. Drug-formulary checks
2. Incorporate clinical lab test results as structured
data
3. Generate lists of patients by specific conditions
4. Send reminders to patients per patient preference for
preventive/follow up care
5. Provide patients with timely electronic access to their
health information ……… more
10/1/2010 53VITL - V.8.1
EP Menu Set Objectives
Stage 1: pick 5 of 10
6. Use certified EHR to identify patient-specific
education resources and provide to patient
7. Medication reconciliation
8. Summary of care record for each transition of
care/referrals
9. Capability to submit electronic data to immunization
registries/systems*
10.Capability to provide electronic syndromic
surveillance data to public health agencies*
10/1/2010 54VITL - V.8.1
* Must include at least one public health transaction
EP Core and Alternate
Clinical Quality Measures
Core
1. Hypertension: Blood
Pressure Measurement
2. Preventive Care and
Screening Measure
a. Tobacco Use Assessment
b. Tobacco Cessation
Intervention
3. Adult Weight Screening
and Follow-up
Alternate
1. Weight Assessment and
Counseling for Children
and Adolescents
2. Preventive Care and
Screening:
Influenza Immunization
for Patients 50 Years
Old or Older
3. Childhood
Immunization Status
10/1/2010 55VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 38
1. Diabetes: Hemoglobin A1C poor control
2. Diabetes: LDL Management and Control
3. Diabetes: BP Management
4. Heart Failure: Ace/ARB Rx for LVSD
5. CAD: Beta Blocker therapy for prior MI
6. Pneumonia Vaccination for Older Adults
7. Breast CA screening
8. Colorectal Cancer screening
10/1/2010 56VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 38
9. CAD: Oral Antiplatelet Therapy Prescribed
for Patients with CAD
10.Heart Failure: Beta Blocker Therapy for
LVSD
11.Anti-depressant medication management:
a. Effective acute phase treatment
b. Effective continuation phase treatment
12.Primary Open Angle Glaucoma (POAG):
Optic Nerve Evaluation
10/1/2010 57VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 38
13.Diabetic Retinopathy: Documentation of
presence or absence of Macular Edema and
level of severity of retinopathy
14.Diabetic Retinopathy: Communication with
the Physician managing ongoing diabetes
15.Asthma Pharmacologic Therapy
16.Asthma Assessment
17. Appropriate testing for children with
pharyngitis
10/1/2010 58VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 3818.Oncology Breast Cancer: Hormonal Tx for
Stage IC-IIIC Estrogen/Progesterone Receptor
Positive CA
19.Oncology Colon Cancer: Chemo for Stage III
CA patients
20.Prostate CA: Avoid overuse of Bone Scan for
Staging Low Risk pts
21.Smoking/Tobacco Use Cessation
a. Advise smokers and tobacco users to quit
b. Discuss smoking/tobacco use cessation medications
c. Discussing smoking/tobacco use cessation strategy10/1/2010 59VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 3822.Diabetes: Eye Exam
23. Diabetes: Urine screening
24. Diabetes: Foot Exam
25.CAD: Drug therapy for lowering LDL
26. Heart Failure: Warfarin therapy for A-Fib
27. IVD: BP Management
28. IVD: Use of aspirin or another antithrombotic
29. Initiation and engagement of alcohol and
other drug dependence treatment: Initiation
and Engagement
10/1/2010 60VITL - V.8.1
EP Clinical Quality Measures
Pick 3 of 3830. Prenatal Care: Screening for HIV
31. Prenatal Care: Anti-D Immunoglobulin
32. Controlling High BP
33.Cervical Cancer Screening
34.Chlamydia Screening for Women
35. Use of Appropriate Medications for Asthma
36. Low Back Pain: Use of Imaging Studies
37. IVD: Complete Lipid Panel and LDL Control
38. Diabetes: HBA1C Control (<8.0%)
10/1/2010 61VITL - V.8.1
EH –14 Core ObjectivesNeed all 14
1. Computerized physician order entry (CPOE)
2. Drug-drug and drug-allergy interaction checks
3. Record demographics
4. Implement one clinical decision support rule
5. Maintain an up-to-date problem list of current
and active diagnoses
6. Maintain active medication list
7. Maintain active medication allergy list
8. Record and chart changes in vital signs
9. Record smoking status for patients 13 years or
older
10/1/2010 62VITL - V.8.1
EH –14 Core ObjectivesNeed all 14
10.Report hospital clinical quality measures
11.Provide patients with an electronic copy of their
health information, upon request
12.Provide patients with an electronic copy of their
discharge instructions at time of discharge, upon
request
13.Capability to exchange key clinical information
among providers of care and patient-authorized
entities electronically
14.Protect electronic health information
10/1/2010 63VITL - V.8.1
EH Menu Set ObjectivesStage 1: Pick 5 of 10
1. Drug-formulary checks
2. Record advanced directives for patients 65 years or
older
3. Incorporate clinical lab test results as structured
data
4. Generate lists of patients by specific conditions
5. Use certified EHR technology to identify patient-
specific education resources and provide to patient, if
appropriate
10/1/2010 64VITL - V.8.1
EH Menu Set Objectives
Stage 1: pick 5 of 10
6. Medication reconciliation
7. Summary of care record for each transition of
care/referrals
8. Capability to submit electronic data to immunization
registries/systems*
9. Capability to provide electronic submission of
reportable lab results to public health agencies*
10. Capability to provide electronic syndromic
surveillance data to public health agencies*
*At least 1 public health objective must be selected
10/1/2010 65VITL - V.8.1
EH Clinical Quality MeasuresNeed all 15
1. Emergency Department Throughput –admitted
patients –Median time from ED arrival to ED
departure for admitted patients
2. Emergency Department Throughput –admitted
patients –Admission decision time to ED departure
time for admitted patients
3. Ischemic stroke –Discharge on anti-thrombotics
4. Ischemic stroke –Anticoagulation for A-fib/flutter
5. Ischemic stroke –Thrombolytic therapy for patients
arriving within 2 hours of symptom onset
10/1/2010 66VITL - V.8.1
EH Clinical Quality MeasuresNeed all 15
6. Ischemic or hemorrhagic stroke –Antithrombotic
therapy by day 2
7. Ischemic stroke –Discharge on statins
8. Ischemic or hemorrhagic stroke – Stroke education
9. Ischemic or hemorrhagic stroke –Rehabilitation
assessment
10/1/2010 67VITL - V.8.1
EH Clinical Quality MeasuresNeed all 15
10. VTE prophylaxis within 24 hours of arrival
11. Intensive Care Unit VTE prophylaxis
12. Anticoagulation overlap therapy
13. Platelet monitoring on unfractionated heparin
14. VTE discharge instructions
15. Incidence of potentially preventable VTE
10/1/2010 68VITL - V.8.1
