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Making Meaningful Use Reports Meaningful
October 14 th, 2011
Making Meaningful Use Reports Meaningful
- 0 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Agenda
MAeHC experience
Why we measureWhy we measure
HIT and CQM
Using CQM data
What is the future of CQMWhat is the future of CQM
Changing healthcare landscape
National Quality Strategy
Questions, comments, discussion
- 1 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Questions, comments, discussion
MAEHC Mission: Facilitate universal EHR adoption
• Company launched September 2004
–Non-profit registered in the –Non-profit registered in the Commonwealth of Massachusetts
• CEO on board January 2005
• Backed by broad array of 34 non-• Backed by broad array of 34 non-profit MA health care stakeholders
- 2 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
MAeHC Selected three pilot sites from 35 Applicants : Brockton, Newburyport, North Adams
• Provided EHRs to ~600 clinicians practicing in over 200 office locations
• Created health information exchanges connecting the physicians with each other and with the hospitals
• Created a quality data center to extract clinical data
- 3 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
from EHRs to evaluate effectiveness and measure performance
MAeHC architecture and data flows
Outcomes analysis
BenchmarkingAnalysis and Reporting
Reporting to plans, others?
Quality Data Center
Community-level: HIE
Brockton Newburyport North Adams
Community-level: HIE
Provider-level: EHR
- 4 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Provider-level: EHR
Since the pilot program, MAeHC has expanded its exp erience base and involvement in a variety of projects
300 Physician EHR implementation – Beth Israel Deaconess Physician Organization (BIDPO)
Community-wide EHR Implementation and HIE planning project – Large Healthcare Foundation
HEAL 5 New York – New York State Department of Health and New York eHealth HEAL 5 New York – New York State Department of Health and New York eHealth Collaborative (NYeC)
HEAL 10 New York – Adirondack Region Patient Centered Medical Home Pilot
State-level HIE technical services vendor procurement – Missouri , North Carolina
State Level Health Information Exchange Strategic and Operational Plan Development – New Hampshire– New Hampshire
Regional Extension Center planning, deployment, and operations – New York, Massachusetts, Rhode Island, New Hampshire
- 5 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Agenda
MAeHC experience
Why we measureWhy we measure
HIT and CQM
Using CQM data
What is the future of CQMWhat is the future of CQM
Changing healthcare landscape
National Quality Strategy
Questions, comments, discussion
- 6 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Questions, comments, discussion
What is a measure?
Meas•ure n. A standard: a basis for comparison; a reference
point against which other things can be evaluated; “they set the point against which other things can be evaluated; “they set the
measure for all subsequent work.” v. To bring into comparison
against a standard.
- 7 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
We know we can’t measure everything
Not everything that counts can be counted, and not everything that can be counted counts.
~Albert Einstein
But…
You can’t improve what you don’t measure
- 8 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
You can’t improve what you don’t measure
Why measure?
Measures drive improvement. Teams of healthcare providers who review their performance measures are able to make adjustments in care, share successes, and probe for causes when progress comes up short — all on the road to improved patient probe for causes when progress comes up short — all on the road to improved patient outcomes.
Measures inform consumers. As a growing number of measures are publicly reported, Measures inform consumers. As a growing number of measures are publicly reported, consumers are better able to assess quality for themselves, and then use the results to make choices, ask questions, and advocate for good healthcare. Some providers now post performance measures on their websites, and consumers can consult national sources such as www.HospitalCompare.hhs.gov and www.Medicare.gov/NHComparesources such as www.HospitalCompare.hhs.gov and www.Medicare.gov/NHCompare
Measures influence payment . Increasingly, private and public payers use measures as preconditions for payment and targets for bonuses, whether it is paying providers for performance or instituting nonpayment for complications associated with NQF’s list of “Serious Reportable Events.”
Source: NQF 2011
- 9 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Agenda
MAeHC experience
Why we measureWhy we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality Strategy
Questions, comments, discussion
- 10 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Linkage of Health IT and measurement
• Capture the right data, in the right format (CPT, ICD, LOINC)Data Sources ICD, LOINC)Data Sources
• Calculate the performance measureCQM • Calculate the performance measureCQM
• Provide real-time information to the clinician with • Provide real-time information to the clinician with decision supportEHR and HIT Tools
• Publicly report for accountability, payment, public health, and comparative effectivenessE-Infrastructure
Source: NQF 2011
- 11 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Source: NQF 2011
Meaningful Use CQM objective
Improve quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparitiesImprove quality, safety, efficiency and reduce health disparities
Ob
ject
ive Report ambulatory clinical quality
measures to CMS or the States: Core: Hypertension, Tobacco Use
Sta
nd
ard For 2011, provide aggregate
numerator, denominator, and exclusions through attestation as
Ob
ject
ive
Core: Hypertension, Tobacco Use Assessment & Cessation Intervention, Adult Weight Screening (NQF 13, 28, 421 or PQRI 128) Menu: Must choose 3
Sta
nd
ard
exclusions through attestation as discussed in section II(A)(3) of this final rule. For 2012, electronically submit the clinical quality measures.PQRI 128) Menu: Must choose 3
measures to reportquality measures.
Requires only Yes / No Attestation Exclusion CriteriaRequires only Yes / No Attestation Exclusion Criteria
X None
http://healthcare.nist.gov/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.0.pdf
http://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.0.pdf
- 12 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
http://healthcare.nist.gov/docs/170.306.i_CalcSubmitClinQualityMeasures_v1.0.pdf
CQM is based on current standards – NQF, PQRI
http://www.ama -assn.org/ama1/pub/upload/mm/399/ehr -clinical -quality -measures.pdf
Population may be all patients, patients seen, or unique patients
- 13 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
http://www.ama -assn.org/ama1/pub/upload/mm/399/ehr -clinical -quality -measures.pdf
Key to CQM success
Keep required data in reportable fields
Code and document completely; missing values or missing information = lower Code and document completely; missing values or missing information = lower performance
Information should be kept as structured data in searchable/sortable fields rather Information should be kept as structured data in searchable/sortable fields rather than free-text
Establish workflows and maximize staff capabilities to enter data elements, i.e. support staff can enter problems, medications, allergies and history
Patient/Medical/System reasons for exclusions should be documented and coded; helps to improve scores by legitimately reducing the denominatorhelps to improve scores by legitimately reducing the denominator
- 14 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Meaningful Use CQM issues
Must select 3 additional CQMs that your EHR is certified to submit
Centricity meets the following clinical quality measures: NQF 0013, NQF 0024, NQF 0028, NQF 0038, NQF 0041, NQF 0059, NQF 0061, NQF 0064, NQF 0421.
CQM reporting tool must be certified if it is outside your EHR (MQIC)
Use “bundled” EHR when registering using additional software packagesUse “bundled” EHR when registering using additional software packages
Incorrect data mapping by vendor – understanding triggers for calculations
Submission can be “0/0”Submission can be “0/0”
- 15 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Agenda
MAeHC experience
Why we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality StrategyNational Quality Strategy
Questions, comments, discussion
- 16 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
CQM data must be relevant, timely and actionable
What you did What you are doing What you should do
Historical data based on claims
collected post visit with time delay
Current data incorporating eRX, orders and some
test results
CDS based on real time ICD/CPT data, eRX, results, and
approved protocols
EHR Implementation and Adoption
- 17 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
CQM data must be relevant, timely and actionable
CMS has acknowledged that the CQM reporting requirement in Stage 1 is no more than that—a reporting requirement meant to get physicians comfortable with the process of that—a reporting requirement meant to get physicians comfortable with the process of reporting.
CMS is under no illusions that the data collected will be meaningful as a measure of the level or quality of care being provided. level or quality of care being provided.
Many physicians will be reporting on problems for which they are not treating the patients, which means that measure numerators will be zero (or very low) and that duplicate data will be submitted by different physicians for the same patients for the duplicate data will be submitted by different physicians for the same patients for the same conditions, which will result in an underestimation of the true care being delivered.
- 18 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Individual scores
Source:MAeHC QDC
- 19 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
MAeHC QDC
Peer-to-Peer comparison
Source:MAeHC QDC
- 20 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
MAeHC QDC
Benchmark against standards
- 21 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Source:MAeHC QDC
Other ways your data warehouse can present data?
Longitudinal scorecards to show variation over timeLongitudinal scorecards to show variation over time
Scorecards by payer to facilitate Quality Contracts (PFP)
Scorecards by CQM for treatment comparison
Local, regional and national benchmarksLocal, regional and national benchmarks
- 22 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Agenda
MAeHC experience
Why we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality StrategyNational Quality Strategy
Questions, comments, discussion
- 23 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Measures are getting better defined, but measure proliferation is a growing concern but measure proliferation is a growing concern
Meaningful Use Stage 1
44 measures
PQRS
187 measures
NCQA HEDIS /PCMH
Numerous measure choices
NQF
730+ Measures
+choices
+ +
Intent of measures often are very similar, but very few if any Intent of measures often are very similar, but very few if any measures have same definitions across categories
- 24 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
What the future holds for MU – Stage 2 and Stage 3
- 25 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Future framework for the reporting of CQM
The Stage 2 recommendations for CQM reporting that the HIT Policy Committee has forwarded to CMS significantly expand on the Stage 1 Committee has forwarded to CMS significantly expand on the Stage 1 measures in an attempt to address a broader set of factors that affect quality, as well as to be relevant to a wider set of physicians, including specialists.
Providers would report on some number of the core measures, (between 5 and all 8 or 9 is the recommendation), and at least one measure from each of the 6 menu “domains”.
The core quality measure set would include all of the core and alternate core measures from Stage 1 and an additional 2 measures related to care coordination.
The intention is that all providers (including specialists) will find measures relevant to their specialty in the core set as well as in each of the domains
- 26 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Future framework for the reporting of CQM
The intention is to broaden the scope of reporting to address a wider spectrum of factors affecting care and to accommodate all types of physicians. All providers will find measures relevant to their specialty in the core set as well as in each of the domains
- 27 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
relevant to their specialty in the core set as well as in each of the domains
Agenda
MAeHC experience
Why we measureWhy we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality Strategy
Questions, comments, discussion
- 28 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
The health reform law included a section that direc ted the HHS Secretary to establish a “Shared Savings Program”Secretary to establish a “Shared Savings Program”
“Not later than January 1, 2012, the Secretary shall establish a shared savings program “Not later than January 1, 2012, the Secretary shall establish a shared savings program that promotes accountability for a patient population and coordinates items under parts A and B, and encourages investment in infrastructure and redesigned care processes for high quality and efficient service delivery”
Allows groups of providers of services and supplier s to manage and coordinate care for Medicare fee -for -services beneficiaries through an “Accountable Care care for Medicare fee -for -services beneficiaries through an “Accountable Care Organization” or ACO
- 29 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Source: Social Security Act Sec. 1899
A shift to ACOs will increase demand for informatio n
Clinical information to support:
�Care coordination
�Evidence Based Medicine (EBM)
Immature In early use Mature
�Risk adjustment for patient population
Quality information to support:
�Reporting on clinical processes and outcomes
�Reporting on patient/caregiver experience of care
�Reporting on utilization (e.g., Preventable hospital admissions)
�Referral decisions (e.g., quality score for a lab, specialist practice, or provider)specialist practice, or provider)
Administrative/financial information to support:
�Payment – FFS
�Payment – Capitation, bundled payment, P4P
�Payment – Shared savings
�Referral decisions (e.g., rate cards for a lab, specialist practice, or provider)
- 30 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
�Assignment of patients to ACO
A shift to ACOs will increase demand for integratio n
Enterprise
Meaningful Use capability
Clinical integration capability
Accountable care capability
Population, Risk, and Financial Management
Population, Risk, and Financial Management
Enterprise Integration & Management
• Business alignment
• Business integration
Measurement &
Case management & longitudinal
viewing
Measurement &
Management
Case management & longitudinal
viewing
Measurement &
Management
• Performance mgmt
• Team-based care
• Patient engagement
Measurement & Reporting
Registries & Repositories
Measurement & Reporting
Registries & Repositories
Measurement & Reporting • Population mgmt
• Utilization mgmt
• Case facilitationRegistries & Repositories
EHR functions
Clinical messaging
EHR functions
Clinical messaging
EHR functions
Clinical messaging
EHR functions
Clinical messaging • Become electronic
• Fill in gaps in care transitions
- 31 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Independent actors
IDNACOIPA/PHO
EHR penetration will lead to proliferation of inter facing requirements
Clinicians will soon face too many measure
ehr ehr ehr ehr
definitions and too many proprietary reporting methods to respond to
Both sides will be exposed to ongoing technology and
Measure recipients will face too many disparate systems, incomplete
technology and market changes
systems, incomplete implementations, and inaccurate measure reports
PayorContracts
CMS MU CMS PQRS Public health
Others?
- 32 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Is there a better way?
ehr ehr ehr ehr
Data Warehouse
Payers
CMS MU
CMS PQRS
Public health
Others
- 33 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
CMS MU Public health
Agenda
MAeHC experience
Why we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality StrategyNational Quality Strategy
Questions, comments, discussion
- 34 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Federal Health IT Strategic Plan 2011-2015
Interoperability Goals Drive RoadmapInteroperability Goals Drive Roadmap
Facilitate Information Exchange to support Meaningful Use of EHRs (Goal 1,
Objective B)
WHAT we want to do
Objective B)
Ensure that HIE takes place across individual exchange models, and
advance health systems and data interoperability interoperability (Strategy 1.B.3)advance health systems and data interoperability interoperability (Strategy 1.B.3)
� Improved care coordination
�Patient access and engagement�Patient access and engagement
� Improved decision-making
�Population health / learning health care system
WHY?INTEROPERABILITY GOALS
�Population health / learning health care system
HOW we will do it
STANDARDS
� Standards &
Interoperability Framework
SERVICES
� State HIE Cooperative
Agreement
POLICIES
� Governance regulations
� MU regulations
36
HOW we will do it Interoperability Framework Agreement
� Direct Project
� NwHIN Infrastructure
� MU regulations
� S&C regulations
� State policy levers
Eyes on the Prize: National Quality StrategyEyes on the Prize: National Quality Strategy
� Aims� Aims– Better Care: Improve quality, by making health care more patient-centered,
reliable, accessible, and safe
– Healthy People and Communities: Improve health of population – Healthy People and Communities: Improve health of population
– Affordable Care: Reduce cost of quality health care
� Six Priorities and Goals to help focus public and private efforts:– Safer Care: eliminate preventable health care-acquired conditions– Safer Care: eliminate preventable health care-acquired conditions
– Effective Care Coordination
– Person- and Family-Centered Care
– Prevention and Treatment of Leading Causes of Mortality: prevent and reduce – Prevention and Treatment of Leading Causes of Mortality: prevent and reduce
harm caused by cardiovascular disease
– Support Better Health in Communities
– Make Care More Affordable– Make Care More Affordable
National Quality Strategyhttp://www.healthcare.gov/center/reports/quality03212011a.html#append
Agenda
MAeHC experience
Why we measure
HIT and CQM
Using CQM data
What is the future of CQM
Changing healthcare landscape
National Quality StrategyNational Quality Strategy
Questions, comments, discussion
- 38 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
How Measures Will Serve Our Future
“Measures are becoming both more precise and more complex. The next generation of
measures will span healthcare settings and episodes of care to present a more
complete picture of care. In the public arena, reporting of measures will become clearer
and easier for patients and their families to understand and use. Wider adoption of
electronic health records (EHRs) can spur measure use enormously. A tremendous
boom for patient care and patient experience, EHRs put all the relevant information,
including a patient’s medical history, at a provider’s fingertips. Patients can avoid including a patient’s medical history, at a provider’s fingertips. Patients can avoid
duplicate tests or imaging. EHRs will also make measurement and performance data
available on a real-time basis, making healthcare much more responsive to patient
needs. Without good data, healthcare systems simply cannot accurately measure and needs. Without good data, healthcare systems simply cannot accurately measure and
assess performance.”
Source: NQF 2011
- 39 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Source: NQF 2011
Jeff Loughlin Jen Monahan Leo McNamaraJeff Loughlin Jen Monahan Leo McNamaraExecutive Director Program Coordinator Project Manager(508) 326-3944 (603) 717-5420 (781) 434-7755
[email protected] [email protected] [email protected]
Nancy Fennell Jaime Dupuis Dave Delano Practice Consulting Practice Consulting CAH Consultant(603) 717-5021 (603) 717-5225 (339) 222-4036
[email protected] [email protected] [email protected]@maehc.org [email protected] [email protected]
Regional Extension Center of New Hampshirec/o New Hampshire Medical Society
7 North State Street7 North State StreetConcord, NH 03301Tel: 603.717.5420Fax: [email protected]
- 40 -Massachusetts eHealth Collaborative © MAeHC. All rights reserved.
Massachusetts eHealth Collaborative © MAeHC. All rights reserved.