S2MU Part II: Choosing wisely among Menu Requirements and Clinical Quality Measures

1. S2MU Part II: Choosing wisely among Menu Requirements and Clinical Quality Measures Moderator: Mary Zile, BSN, MHSA Speakers: Andrew Bledsoe, MBA Nathan Diller, MBA, MHSA

2. Agenda • Overview of Meaningful Use • Deep Dive: S2MU Menu Measures • Deep Dive: Clinical Quality Measures • Question & Answers

3. Overview of Meaningful Use

4. Definition of Meaningful Use • Use of ONC-HIT Certified Electronic Health Records (EHR) • Electronic Exchange of Health Information • Quality Reporting

5. HITECH: Policy Framework Better care for individuals, better health for populations, and lower per-capita costs. IHI-Triple Aim Initiative

6. Pillars of Meaningful Use • Improve 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 health • Improve care coordination • Exchange meaningful clinical information among professional health care team • Improve 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

8. 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

9. Stages of Meaningful Use http://www.cms.gov/EHRIncentivePrograms

11. For Medicare Hospitals:

12. Medicare Payment Adjustments • Medicare EPs who are not meaningful users will be subject to a payment adjustment beginning on January 1, 2015.

13. 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.

14. Hardship Exceptions for Medicare EPs • EPs can apply for hardship exceptions in the following categories: • Infrastructure • New EPs • Unforeseen circumstances • By specialist/provider type

15. Meaningful Use – Who is eligible for incentives? No Changes from Stage 1 Meaningful Use

16. S2MU Change in Total Objectives Required

17. How to Get to S2MU • 17 Core Objectives 3 of 6 Menu Objectives 9 Clinical Quality Measures Meaningful Use

18. Deep Dive: S2MU Menu Measures

19. Stage 2 MU EP Menu Objectives

20. EP Menu Set Requirements

21. EP Menu Set Requirements

22. EP Menu Set Requirements

23. EP Menu Set Requirements

24. EP Menu Set Requirements

25. EP Menu Set Requirements

26. Deep Dive: Clinical Quality Measures

27. Domains

28. 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.

29. 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.

30. 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.

31. Clinical Quality Measures

32. 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

33. Reporting Options for EP’s – 2014 and After

34. Recommended Core CQM’s • For 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

35. Recommended Core CQM’s

36. Recommended Core CQM’s

37. CQM By Specialty • The 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

38. 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

39. Reporting Specifications • Each 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.    

40. Q&A Session

41. 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/

42. References / Resources • http://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

43. References / Resources • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Electronic_Reporting_Spec.html