e-module Centers for Medicaid and Medicare (CMS) Core Measures

Transcription

1 Centers for Medicaid and Medicare (CMS) Core Measures 1

2 Purpose The purpose of this e-learning module is to provide education for health care providers on Core Measures. This module is not all inclusive, but rather provides an overview of salient points related to Core Measures. 2

3 Objectives 1. The learner will define Core Measures. 2. The learner will list the Quality Measures for NSLIJHS top three Core Measure diagnoses. 3. The learner will identify health team members roles in carrying out core measure quality measures. 3

4 Directions Please review this module in its entirety. When you have finished, take the post test. Passing score is 100%. 4

5 Definition of Core Measures A standardized set of performance measures that are illness or condition specific. 5

6 Purpose of Core Measures Core measures allow the institution to: Measure quality patient care Identify treatment standards for specific illness or conditions Provide documentation required for reimbursement 6

7 Core Measures Core measures ensure a minimum standard of care for all patients who come in with core measure diagnoses. Care is no longer solely based on how good your doctor is! Minimized variances in what interventions patients receive. 7

8 Examples of Core Measures Acute Myocardial Infarction Heart Failure Community Acquired Pneumonia CABG Total Abdominal Hysterectomy Total Hip/ Total Knee surgeries 8

9 NSLIJHS Top 3 Core Measures Acute MI Heart Failure Community Acquired Pneumonia 9

10 Quality Measures Quality measures are interventions and outcomes that we want the patient to experience. Healthcare organizations are measured based on their ability to meet all of quality measures for each core measure diagnosis. 10

11 Quality Measures for Acute Myocardial Infarction Administering ASA on arrival Administering beta blocker on arrival Administering ACE Inhibitor or ARBs for LVSD (left ventricular systolic dysfunction) Administering fibrinolytic medications within 30 min Performing percutaneous coronary interventions within 90 min or arrival Smoking cessation counseling Prescriptions at discharge ASA Beta Blocker ACE Inhibitor/ARB 11

12 Quality Measures for Heart Failure Left ventricular function assessment Echocardiogram Ejection Fraction % ACEI or ARB s for LVSD (left ventricular systolic dysfunction) Prescriptions at discharge for ACEI or ARB s Smoking cessation counseling Written discharge instructions activity level diet follow-up appointment weight monitoring what to do if symptoms worsen 12

13 Quality Measures for Community Acquired Pneumonia Oxygen assessment within 24 hours of arrival to hospital Arterial blood gas Pulse oximetry Blood cultures when appropriate and before first dose of antibiotic Proper antibiotic selection Administering timely antibiotics within 6 hours Assess pneumococcal and influenza status Smoking cessation counseling Click here to view (NSUH) Adult Pneumonia admission order set 13

14 Primary and Secondary Core Measure diagnoses If the patients primary diagnosis is a core measure ie heart failure, of course, follow the core measure criteria for caring for a patient with heart failure. If the patients primary diagnosis is not a core measure, ie GI Bleed, but the patient has a secondary diagnosis or history of a diagnosis with a core measure ie history of heart failure, ensure that the criteria for caring for a patient with heart failure are included in the current plan of care. 14

15 Responsibilities: On Admission Provider/practitioner: Physicians and Physician Assistants, Nurse Practitioners, Nurse Midwives. Collaborate with interdisciplinary team ensuring that all standards of care are met. Complete correct order set; include all medications related to both the primary and secondary diagnosis Write progress note if intervention is contraindicated for patient. 15

16 Responsibilities: On Discharge Provider/Practitioner: Physicians and Physician Assistants, Nurse Practitioners, Nurse Midwives. Make sure all NEW medications are reconciled with the patients previous medications (State as an example: discharging the patient on Coreg and making sure Lopressor is discontinued) Make sure patient education includes the need to follow-up with specialty physicians related to Core measures 16

17 Responsibilities on Admission and Discharge: Nurse Execute appropriate interventions. Notify provider/practitioner if listed intervention has not been ordered. Perform medication Reconciliation Review admission/ discharge plan with patient 17

18 It s all or nothing! Core measure compliance impacts hospital rankings. Quality measure compliance is publicly reported. Core measure compliance directly Influences reimbursement. Performance in core measures influences consumers (patients) choices in selecting where to seek care. Is all or nothing - there is no partial compliance with core measure criteria. If we miss one quality measure = failure for the entire patient care compliance standard. 18

19 CMS Core Measures You may visit to view your hospitals quality reports on CMS Core Measures. 19

20 References NSLIJHS Standards, Policy, Procedure guidelines NSLIJHS CareMaps NSLIJHS website: CMS website: 20

21 You have completed this module It is required that you take a post assessment after completing this module. Passing score is 100%. Complete the post assessment CMS-Core Measures Quiz which is located on the Quia site 21