CMS & Core Measures
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CMS & Core Measures Keely Dahl Pharm.D. Candidate 2016 Centers for Medicare & Medicaid Services
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Transcript of CMS & Core Measures
CMS & Core Measures
Keely DahlPharm.D. Candidate 2016
CMS: Centers for Medicare & Medicaid Services
Objectives
Distinguish the role of CMS in advancing health information technology
Understand the basic principles of the EHR Incentive Program
Recognize the relationship between CQMs and hospital reimbursement
Appreciate how Shands compares to other hospitals nationwide
CMS: Centers for Medicaid and Medicare Services EHR: Electronic Health Record CQM: Clinical Quality Measure
Pharmacy Student Relevance
CMS EHR Incentive Program data, June 2014Core Measure Excellence Team Meeting, June 2015
The Centers for Medicare & Medicaid Services
US Department of Health and Human Services
The Centers for Medicare and Medicaid.
Medicaid Medicare
The HITECH Act of 2009
The Health Information Technology for Economic and Clinical Health (HITECH) Act
Advancing health information technology (HIT)
“The Stimulus” The American Recovery & Reinvestment Act
(ARRA)
Recovery.gov
CMS: Advancing Health Information Technology
Voluntary Electronic Health Record (EHR) Incentive Program
Meaningful use of certified EHR technology
Health IT Legislation – HITECH ActCMS EHR Incentive Programs
?
EHR Incentive Program
x axis: year of EHR adoption y axis: reimbursement amount per year
Medicare Reimbursement Schedule
Medicare Electronic Health Record Incentive Payments for Eligible Professionals, May 2013EHR Incentive Program for Medicare Hospitals: Calculating Payments, May 2013
Meaningful Use (MU)
Clin
ical
Use
fuln
ess o
f EHR
=
MUST BE ABLE TO: Record Store Clinical Quality Measures Report
Clinical Insights, Core Measures 101Care Cloud, Clinical Quality Measures
Clinical Quality Measures (CQM)
(core measures)
Nationally standardized performance measurements
Measures the rate of occurrence of an evidence-based standard of care
Improvement tool
Quarterly submission to CMS
CMS then publically reports data to encourage transparency
Dictates reimbursement via Hospital Value Based Purchasing
GOALincentivize higher quality of care by rewarding higher
performing hospitals
• Substance Use• Tobacco Treatment• Perinatal Care• Venous Thromboembolism• Hospital Outpatient Department• Pneumonia Measures• Heart Failure• Acute Myocardial Infarction• Stroke• Surgical Care Improvement Project• Hospital-Based Inpatient Psychiatric
Services• Emergency Department• Children's Asthma Care• Immunization
Joint Commission, Core Measure SetsCMS, 2014 Clinical Quality Measures
Clinical Quality Measure (CQM)
Must be STEEEP and MU
SafeTimely EfficientEquitableEffective Patient-Centered
CMS, Clinical Quality Measure for 2014 EHR Incentive Programs
64 Clinical Quality Measures. Hospitals must report on 16 CQMs (2014).Must include at least 3 National Quality Strategy Domains.
CMS, Clinical Quality Measure for 2014 EHR Incentive Programs
Recommended Clinical Quality Measures (CQMs)
CMS has 9 recommended CQMs
Recommended CQMs represent: High priority health conditions
High morbidity and mortality Public health concern Healthcare cost drivers
Best practices
CMS 2014 Clinical Quality Measures
CMS began an initiative in 2011 to reward acute-care hospitals for providing ________.
A) Excellent looking MDs.
B) Edible cafeteria food.
C) Free Opus to all employees.
D) High quality of care.
The Joint Commission
Independent, not-for-profit organization
Accredits & certifies health care organizations
Results of surveys are recognized by: CMS State governments
Joint Commission, About Us
Joint Commission, Annual Report
Real World Application of Quality Measures
Hospital Compare Consumer-oriented website Makes informed decisions easier Compares clinical quality measures (CQMs) Supports hospital quality improvement efforts
Medicare, Hospital Compare
UF Health Shands HospitalHospital Compare
Medicare, Hospital Compare
Benefits and Pitfalls Electronic Health Record Incentive
Program
COST!
Becker’s Health IT & CIO ReviewHealth IT.gov
Meaningful Use Stages 2017
CMS, 2014 Definition Stage 1 of Meaningful UseCMS, Stage 2
Health IT.gov, Meaningful Use Definitions and Objectives
Take Home Points The CMS is responsible for the EHR Incentive Program and Meaningful Use
The EHR Incentive Program has been adopted by the majority of the US
Meaningful Use is the term used to signify that the EHR has clinical benefit
CQMs quantify Meaningful Use
CQMs can be compared amongst hospitals nationwide
Meaningful use is a moving target
CMS: The Centers for Medicare and Medicaid ServicesEHR: Electronic Health RecordCQM: Clinical Quality Measure
CMS & Core Measures
Keely DahlPharm.D. Candidate 2016
CMS: Centers for Medicare & Medicaid Services
