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
S2MU Part II: Choosing wisely among Menu Requirements and Clinical Quality Measures
Moderator:Mary Zile, BSN, MHSA
Speakers: Andrew Bledsoe, MBANathan Diller, MBA, MHSA
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
Agenda
• Overview of Meaningful Use
• Deep Dive: S2MU Menu Measures
• Deep Dive: Clinical Quality Measures
• Question & Answers
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Overview of Meaningful Use
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Definition of Meaningful Use
• Use of ONC-HIT Certified Electronic Health Records (EHR)
• Electronic Exchange of Health Information
• Quality Reporting
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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 UseImprove 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 healthImprove care coordination
• Exchange meaningful clinical information among professional health care teamImprove 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
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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
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
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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
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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
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For Medicare Hospitals:
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Medicare Payment Adjustments
Medicare EPs who are not meaningful users will be subject
to a payment adjustment beginning on January 1, 2015.
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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
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.
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Hardship Exceptions for Medicare EPs
EPs can apply for hardship exceptions in the following categories:• Infrastructure• New EPs• Unforeseen circumstances• By specialist/provider type
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Meaningful Use – Who is eligible for incentives? Eligible Providers in
MedicareEligible Providers in
MedicaidEligible Professionals (EPs) Eligible Professionals (EPs)
Doctor of Medicine or Osteopathy Physicians (Pediatricians have special eligibility & payment rules)
Doctor of Dental Surgery or Dental Medicine
Nurse Practitioners (NPs)
Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs)Doctor of Optometry DentistsChiropractor Physician Assistants (PAs) who
practice in a Federally Qualified Health Center (FQHC) or rural health clinic (RHC) that is led by a PA
Eligible Hospitals Eligible HospitalsAcute Care Hospitals Acute Care HospitalsCritical Access Hospitals (CAHs) Children’s Hospitals
No Changes from Stage 1 Meaningful
Use
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S2MU Change in Total Objectives Required
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Stage 1 MU – Eligible Professionals Stage 2 MU – Eligible Providers15 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
How to Get to S2MU
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17 Core Objectives 3 of 6 Menu Objectives
9 Clinical Quality
Measures
Meaningful Use
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Deep Dive: S2MU Menu Measures
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Stage 2 MU EP Menu ObjectivesMenu 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
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EP Menu Set Requirements
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Objective Stage 1 MU Stage 2 MU Summary of Change
Imaging results consisting of the image itself and
any explanation or other
accompanying information are
accessible through CEHRT
N/A
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.
New Requirement
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
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Objective Stage 1 MU Stage 2 MU Summary of Change
Record patient family health history as structured data
N/A
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.
New Requirement
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
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Objective Stage 1 MU Stage 2 MU Summary of Change
Record electronic notes in patient
records
N/A
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 text-searchable.
New Requirement
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
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Objective Stage 1 MU Stage 2 MU Summary of Change
Capability to submit electronic syndromic
surveillance data to public health
agencies, except where prohibited, and in accordance with applicable law
and practice
N/A
Successful ongoing submission of electronic syndromic surveillance data from CEHRT to a
public health agency for the entire EHR reporting
period.
New Requirement
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
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Objective Stage 1 MU Stage 2 MU Summary of Change
Capability to identify and report cancer cases to a
State cancer registry, except
where prohibited, and in accordance with applicable law
and practice
N/A
Successful ongoing submission of cancer case information from CEHRT to a public health central
cancer registry for the entire EHR reporting
period.
New Requirement
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
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Objective Stage 1 MU Stage 2 MU Summary of Change
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
N/A
Successful ongoing submission of specific case information from
CEHRT to a specialized registry for the entire EHR
reporting period.
New Requirement
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
Deep Dive: Clinical Quality Measures
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Domains
Patient and Family Engagement
Patient Safety Care Coordination
Population/Public HealthEfficient Use of Healthcare Resources
Clinical Process/Effectiveness
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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
PQRS
CHIPRA
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
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 2014 and Beyond*
EPs
Complete 6 out of 44:
3 core or 3 alt. core +
3 menu
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
Eligible Hospitals and CAHs Complete 15 out of 15
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
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Reporting Options for EP’s – 2014 and AfterCategory Data Level Payer Level Submission
TypeReporting 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
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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
Recommended Core CQM’sFor 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
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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
Recommended Core CQM’s
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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
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Recommended Core CQM’s
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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
CQM By SpecialtyThe 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
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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
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
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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
Reporting SpecificationsEach 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.
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Q&A Session
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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/
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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 / Resourceshttp://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html
http://www.healthit.gov/providers-professionals/how-attain-meaningful-use
http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecifications.zip
http://motorcycleguy.blogspot.com/2012/11/hashtag-soup-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 / Resourceshttp://
www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.html
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