Best Practices for CQM Submissions - Xerox · eCAC-3 eVTE-1 eVTE-2 eVTE-3 eVTE-4 eVTE-5 eVTE-6...
Transcript of Best Practices for CQM Submissions - Xerox · eCAC-3 eVTE-1 eVTE-2 eVTE-3 eVTE-4 eVTE-5 eVTE-6...
General CQM Overview
2016 Submission Requirements
2017 Submission Requirements
Selecting the Right Platform
CQM Partner Functionality Considerations
Agenda
October 11, 2016
2 October 12, 2016
HITECH’s Impact on EHR Adoption
• < 10% of hospitals had a basic EHR
• > 20% in only 2 states
2008
• Meaningful Use reporting began
• Basic EHR adoption increased to almost 30%, with 75% being certified systems
2011
• 3 out of 4 hospitals have basic EHR
• 97% of those have certified EHR
2014
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CQM Reporting Timeline
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2010 2012 2014 2015 2016 2017
CQMs developed as quality component of Meaningful
Use Stage 1 – Reporting via attestation
Stage 2 Meaningful Use Final Rule published;
CQMs reporting continues to be required by
MU, but requirements moved to HIQR program
– Electronic reporting becomes an option
Stage 3 Meaningful Use and 2015-
2017 MU Reporting Options rules
published – Reporting via attestation
or electronic submission
HIQR ruling establishes electronic reporting
requirement for 2016 – Reporting via
attestation or electronic submission
Electronic reporting of 4 self-selected
CQMs required for 1 calendar quarter –
Only hospitals who do not participate
in HIQR continue to attest
Electronic reporting of 8 self-selected
CQMs required for full CY – Only
hospitals who do not participate in
HIQR continue to attest
Xerox Confidential
What are
CQMs & Why
are They
Important
CQMs are tools that measure and track the quality of healthcare services provided by hospitals and providers.
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CQMs Support
Achievement of
Health Care
Goals
Better Health
Lower Cost
Better Health Care
Hospitals who participate in HIQR must • Electronically submit 4 CQMs ‒ Self-selected from available 28
inpatient CQMs
• Report one calendar quarter of data (either Q3 or Q4 2016)
• Deadline: February 28, 2017
2016 CQM Reporting Requirements CMS
Consequences of failing to report • Hospitals who fail to meet the
above will lose Medicare Annual Payment Update
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2016 CQMs for CMS
eAMI-1 eAMI-7a eAMI-8a eAMI-10 eSCIP-INF-1
eSCIP-INF-2
eSCIP-INF-9
eCAC-3 eVTE-1 eVTE-2 eVTE-3 eVTE-4 eVTE-5 eVTE-6
eSTK-2 eSTK-3 eSTK-4 eSTK-5 eSTK-6 eSTK-8 eSTK-10
eED-1 eED-2 ePN-6 ePC-01 ePC-05 eEHDI-
1a eHTN
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2016 Reporting Options TJC
Option 1 – Chart
abstracted
reporting only
•Select & report on 6
chart-abstracted
measure sets
•Perinatal care required
for hospitals with >=
300 live births/year
Option 2 – eCQM
reporting only
• Select & report on 8
CQM sets
‒ Data must be reported on at
least ONE eCQM from each
set selected
• Perinatal care required
for hospitals with >= 300
live births/year
Option 3 – Combination of chart-
abstracted and eCQM reporting
• Select and report on 6 measure sets
‒ For eCQM sets, data must be reported on at least
ONE eCQM
• Perinatal care required for hospitals with >=
300 live births/year
•Hospitals encouraged to submit same
chart-abstracted and eCQM sets
‒ Reduces abstraction burden
‒ Report on only 3 sets, credit given for 6
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Chart-abstracted Measure Sets
• ED (-1a, -2a)
• PC (-01, -02, -03, -04, -05)
• STK (-4)
• VTE (-5, -6)
• IMM (-2)
• HBIPS (-1, -2, -3, -5)
• SUB (-1, -2, -3)
• TOB (-1, -2, -3)
• OP (-1, -2, -3, -4, -5, -18, -20, -21, -23)
2016 TJC Measure Options
eCQM Measure Sets
• eAMI (-7a, -8a)
• eCAC (-3)
• eED (-1a, -2a)
• ePC (-01, -05/-05a)
• eSTK (-2, -3, -4, -5, -6, -8, -10)
• eSCIP-INF (-1, -9)
• eVTE (-1, -2, -3, -4, -5, -6)
• eEHDI (-1a)
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Hospitals who participate in HIQR must: • Electronically submit 8 CQMs
‒ Self-selected from available 15 inpatient CQMs
• Report full calendar year
‒ May report quarterly, bi-annually, or annually
• Deadline: February 28, 2018
• 200 hospitals will be selected for validation
‒ Scoring based on ability to submit COMPLETE charts NOT data element matches
‒ Feedback on data element matches will be provided
‒ If selected for chart-abstracted validation exempt from CQM validation
• No public reporting
2017 CQM Reporting Requirements for CMS
Consequences of failing to report OR failing validation • Hospitals who fail to
meet above will lose Medicare Annual Payment Update
10 October 12, 2016
2017 CQMs for CMS
eAMI-1 eAMI-7a eAMI-8a eAMI-10 eSCIP-INF-1
eSCIP-INF-2
eSCIP-INF-9
eCAC-3 eVTE-1 eVTE-2 eVTE-3 eVTE-4 eVTE-5 eVTE-6
eSTK-2 eSTK-3 eSTK-4 eSTK-5 eSTK-6 eSTK-8 eSTK-10
eED-1 eED-2 ePN-6 ePC-01 ePC-05 eEHDI-
1a eHTN
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Chart-abstracted measures • Report on 5 chart-abstracted
MEASURES
• All PC measures required for hospitals with >= 300 live births/year
2017 Reporting Requirements TJC
eCQM measures • Report on 6 eCQMs
• Hospitals encouraged to report on additional eCQMs
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Chart-abstracted Measure Sets
• ED (-1a, -2a)
• PC (-01*)
• VTE (-6)
• IMM (-2)
• PC (-02, -03, -04, -05)
2017 TJC Measure Options
eCQM Measure Sets
• eAMI (-8a)
• eCAC (-3)
• eED (-1a, -2a)
• ePC (-01, -05)
• eSTK (-2, -3, -5, -6)
• eVTE (-1, -2)
• eEHDI (-1a)
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• Identify CQM vendor
• Identify data needs ‒ Strategy for 2016 & 2017 may be to
determine measures for submission and prepare for only those measures
‒ Must keep in mind that CMS will increase measure requirements
Preparing for CQM Submissions
• Map internal client codes to industry standard codes (LOINC, SNOMED, RXNORM)
• Validate CQM results
• Submit ‒ register, review, finalize
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EHR certification edition • Must be 2014 Edition CEHRT for 2016
& 2017
• Must be 2015 Edition CEHRT by January 1, 2018
Ability to submit to The Joint Commission • Must be contracted and meet TJC
requirements
Supports all available CQMs
What to Look for in a CQM Partner
Flexible options for data integration and services to manage data extraction • HL7 interface
• Flat file transmissions
• QRDA (not recommended)
Services to help hospital achieve internal quality objectives • Ensure measure results reflect patient care
• Use data to identify areas of improvement and create transformation strategies
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• Interface system allows data from all systems to be utilized for CQM calculation, ensuring completeness of data
‒ Integrate data from separate systems like ED, OB, Surgery, and other specialties that may not be integrated with certified EHR
‒ Ability to include unstructured data
• Services to assist with data extraction, mapping, submission
‒ Report writing
‒ Mapping experts
Advantages of an Interface System
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COMPLETE DATA =
CQMs BETTER REFLECT PATIENT CARE
Ability to:
• Update client-to-industry code mappings via batch file or on code-by-code basis
• Generate a list of all patients qualifying for any CQM by location
• Summarize CQM results
• View CQM results at patient level
• Analyze data used in calculation
• Manage QRDA file header information
• Choose measures for submission and evaluate readiness
CQM Functionality Considerations
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Data Extraction Services
Data Integration
• Supports All Measures
• Census Report
• Scoring Report
• Measure Category Report
• Analysis Report
Holistic CQM Reporting
Quality Improvement Services
Things to
consider when
selecting a CQM
partner…
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Today in Summary
Questions? Carla McCorkle, Product Manager, Midas+ Live and CPMS
Linda Justice, RN Nurse Executive
For more information contact us at [email protected]
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