2014 Clinical Quality Measures: Changes for the Medicaid EHR Incentive Program. Tracy McDonald Medicaid EHR Incentive Program Coordinator

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1 2014 Clinical Quality Measures: Changes for the Medicaid EHR Incentive Program Tracy McDonald Medicaid EHR Incentive Program Coordinator

2 Agenda Why are Clinical Quality Measures important? Clinical Quality Measures Today Clinical Quality Measures in 2014 Eligible Hospitals Eligible Professionals w/cms Recommendations Lists of all CQMs for Eligible Hospitals and Eligible Professionals

3 Why Are CQMs Important? CQMs Support Achievement of Health Care Goals Better Health Better Health Care Lower Cost Promote evidence-based utilization of clinical processes Measure progress on preventing and treating priority conditions Improve outcomes by identifying deficiencies in safety and accessibility Reduce provider burden (e.g., administrative time and resources) by streamlining quality measurement Improve functional assessment of chronic conditions to more efficiently treat and manage disease Facilitate care coordination across settings Reduce preventable hospital readmissions Decrease medication errors Promote appropriate usage of diagnostic testing and screening for patients 3

4 2013 Clinical Quality Measures Eligible Hospitals (EH) For Stage 1 through the end of FFY 2013, all EHs must report on all 15 CQMs Numerators and denominators can be 0, but still must be reported Eligible Professionals (EP) For Stage 1 through the end of CY 2013, all EPs must report on 6 CQMs 3 CQMs from the Core and/or Alternate Core Set 3 CQMs from the Additional Set Numerators and denominators can be 0, but still must be reported 4

5 CQMs Dropped in EPs NQF # Measure Title 0001 Asthma Assessment 0012 Prenatal Care: Screening for Human Immunodeficiency Virus (HIV) 0013 Hypertension: Blood Pressure Management 0014 Prenatal Care: Anti-D Immune Globulin 0027 Smoking and Tobacco Use Cessation, Medical Assistance: a. Advising Smokers and Tobacco Users to Quit, b. Discussing Smoking and Tobacco Use cessation Medications, c. Discussing Smoking and Tobacco Use Cessation Strategies 0047 Asthma Pharmacologic Therapy 0061 Diabetes: Blood Pressure Management 0067 Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD 0073 Ischemic Vascular Disease (IVD): Blood Pressure Management 0074 Coronary Artery Disease (CAD): Drug Therapy for Lowering LDL-Cholesterol 0084 Heart Failure (HF): Warfarin Therapy Patients with Atrial Fibrillation 0575 Diabetes: Hemoglobin A1c Control (<8.0%) 5

6 Special Note about Attesting to 2013 CQMs If you are attesting in Program Year 2013 using a 2014 Certified Health Record Technology (CEHRT), your CQM choices will have changed EPs EHs Only 32 of the 44 CQMs from Stage 1 are included in Stage 2, so your 2014 (CEHRT) will only have 32 CQMs to choose from NQF 0013 (Hypertension: Blood Pressure Management) is a Core CQM that is not available with a CEHRT; choose an alternate core CQM All currently required 15 CQMs from Stage 1 are included in Stage 2 6

7 2014 Clinical Quality Measures

8 What s new for 2014? All Meaningful Use attestations will submit their CQMs in accordance with the 2014 changes Yes, even Stage 1 Stage 2 CQMs must cover at least 3 of the 6 National Quality Strategy domains 8

9 What s new for 2014? Patient Safety Patient & Family Engagement Care Coordination Make care safer by reducing harm in the delivery of care Ensure that each person and family are engaged as partners in their care Promote effective communication and coordination of care Population & Public Health Efficient Use of Health Care Resources Clinical Processes / Effectiveness Work with communities to promote wide use of best practices to enable healthy living Make quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models Improve quality, safety and efficiency; reduce health disparities 9

10 2014 CQMs for Eligible Hospitals EHs need to submit 16 CQMs from a total list of 29 See the appendix at the end of this presentation for a complete list Patient and Family Engagement 5 ea. Patient Safety 6 ea. Care Coordination 2 ea. Efficient Use of Health Care Resources 2 ea. Clinical Processes / Effectiveness 14 ea. 10

11 2014 CQMs for Eligible Professionals EPs need to submit 9 CQMs from a total list of 64 See the appendix at the end of this presentation for a complete list Patient and Family Engagement 4 ea. Patient Safety 6 ea. Care Coordination 1 ea. Population & Public Health 9 ea. Efficient Use of Health Care Resources 4 ea. Clinical Processes / Effectiveness 40 ea. 11

12 Before Choosing CQMs Before choosing which CQMs you are going to report on, TALK TO YOUR VENDOR Is your product certified for the following: To capture and export For electronic submission To import and calculate What measures are your product certified to submit? You can also check on the ONC Certified Health IT Product List at Does you practice have any quality improvement (QI) efforts underway related to any of the CQMs? If you are participating in other QI efforts, don t reinvent the wheel; keep it easy 12

13 CMS Recommended CQMs for EPs CMS published a recommended core set of CQMs for adult and pediatric practices These were chosen by CMS based on several factors: Conditions that contribute to the morbidity and mortality of Medicare and Medicaid beneficiaries Conditions that represent national public health priorities Conditions that are common health disparities Conditions that disproportionately drive health care costs and could improve with better quality measurement Measurements that would enable CMS, States and EPs to measure quality of care in new dimensions Measures that include patient and/or caregiver engagement 13

14 2014 Adult Recommended CQMs CQM Number CQM Title Domain NQF 0018 NQF 0022 NQF 0028 NQF 0052 NQF 0418 NQF 0419 NQF 0421 Controlling High Blood Pressure Use of High-Risk Medications in the Elderly Tobacco Use: Screening and Cessation Intervention Use of Imaging Studies for Low Back Pain Screening for Clinical Depression and Follow-up Plan Documentation of Current Medications in the Medical Record Body Mass Index (BMI) Screening and Follow-up Clinical Process / Effectiveness Patient Safety Population/Public Health Efficient Use of Healthcare Resources Population/Public Health Patient Safety Population/Public Health NQF TBD Receipt of Specialist Report Care Coordination NQF TBD Functional Status Assessment for Complex Chronic Conditions Patient and Family Engagement 14

15 2014 Pediatric Recommended CQMs CQM Number CQM Title Domain NQF 0002 NQF 0024 Appropriate Testing for Children with Pharyngitis Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Efficient Use of Healthcare Resources Population/Public Health NQF 0033 Chlamydia Screening for Women Population/Public Health NQF 0036 Use of Appropriate Medications for Asthma Clinical Process/Effectiveness NQF 0038 Childhood Immunization Status Population/Public Health NQF 0069 NQF 0108 NQF 0418 NQF TBD Appropriate Treatment for Children with Upper Respiratory Infection ADHD: Follow-up Care for Children Prescribed ADHD Medication Screening for Clinical Depression and Follow-up Plan Children who have Dental Decay or Cavities Efficient Use of Healthcare Resources Clinical Process/Effectiveness Population/Public Health Clinical Process/Effectiveness 15

16 Submitting CQMs through the CO R&A Medicaid EPs and Medicaid-only EHs will submit their CQMs through the CO R&A The update for the CO R&A is scheduled for late 2014 Currently, the CO R&A will accept CQM uploads, but all of the new CQMs will be added Medicaid EPs and Medicaid-only EHs will not need to submit their CQMs to CMS Attesting in the CO R&A will fulfill the requirement that all CQMs are reported on electronically 16

17 Resources Colorado Registration & Attestation (CO R&A) System: New! Meaningful Use Resources for EPs & EHs Including all PY 2013 Workbooks & Recorded Events Guide for Reading Eligible Professional (EP) and Eligible Hospital (EH) emeasures Guidance/Legislation/EHRIncentivePrograms/Downloads/Gui de_reading_ep_hospital_ecqms.pdf 17

18 Appendix 2014 CQMs for Eligible Hospitals CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain ED-1 Emergency Department Throughput Median time from ED arrival to ED departure for admitted ED patients Patient & Family Engagement ED-2 Emergency Department Throughput admitted patients Admit decision time to ED departure time for admitted patients Patient & Family Engagement Stroke-2 Ischemic stroke Discharged on anti-thrombotic therapy Stroke-3 Ischemic stroke Anticoagulation Therapy for Atrial Fibrillation/Flutter Stroke-4 Ischemic stroke Thrombolytic Therapy Stroke-5 Ischemic stroke Antithrombotic therapy by end of hospital day two (2) Stroke-6 Ischemic stroke Discharged on Statin Medication Stroke-8 Ischemic or hemorrhagic stroke Stroke education Patient & Family Engagement Stroke-10 Ischemic or hemorrhagic stroke Assessed for Rehabilitation Care Coordination Venous Thromboembolism (VTE)-1 VTE prophylaxis Patient Safety VTE-2 Intensive Care Unit (ICU) VTE prophylaxis Patient Safety VTE-3 VTE Patients with Anticoagulation Overlap Therapy VTE-4 VTE Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram) VTE-5 VTE discharge instructions Patient & Family Engagement VTE-6 Incidence of potentially preventable VTE Patient Safety AMI-2 Aspirin Prescribed at Discharge for AMI PC-01 Elective Delivery Prior to 39 Completed Weeks Gestation 18

19 Appendix 2014 CQMs for Eligible Hospitals (Cont.) CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain AMI-7a Fibrinolytic Therapy Received Within 30 minutes of hospital arrival AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival AMI-10 Statin Prescribed at Discharge PN-6 Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients Efficient Use of Healthcare Resources SCIP-INF-1 Prophylactic Antibiotic Received within 1Hour Prior to Surgical Incision Patient Safety SCIP-INF-2 Prophylactic Antibiotic Selection for Surgical Efficient Use of Healthcare Patients Resources SCIP-INF-9 Urinary catheter removed on Postoperative Day (POD1) or Postoperative Day 2 (POD2) with day of surgery being day zero Patient Safety ED-3 Median time from ED arrival to ED departure for discharged ED patients Care Coordination Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver Patient & Family Engagement Exclusive Breast Milk Feeding Health Term Newborn Patient Safety EHDI-1a Hearing screening before hospital discharge To see a full description of each measure, including the numerator and denominator statement, visit Guidance/Legislation/EHRIncentivePrograms/Downloads/2014_CQM_EH_FinalRule.pdf 19

20 Appendix 2014 CQMs for Eligible Professionals CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain Appropriate Testing for Children with Pharyngitis Efficient use of Healthcare Resources Initiation and Engagement of Alcohol and Other Drug Dependence Treatment Controlling High Blood Pressure Use of High-Risk Medication in the Elderly Patient Safety Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Population / Public Health Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention Population / Public Health Breast Cancer Screening Cervical Cancer Screening Chlamydia Screening for Women Population / Public Health Colorectal Cancer Screening Use of Appropriate Medications for Asthma Childhood Immunization Status Population / Public Health Preventive Care and Screening: Influenza Immunization Population / Public Health Pneumonia Vaccination Status for Older Adults Use of Imaging Studies for Low Back Pain Efficient Use of Healthcare Resources Diabetes: Eye Exam Diabetes: Foot Exam Diabetes: Hemoglobin A1c Poor Control 20

21 Appendix 2014 CQMs for Eligible Professionals (Cont.) CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain Diabetes: Hemoglobin A1c Poor Control Hemoglobin A1c Test for Pediatric Patients Diabetes: Urine Protein Screening Diabetes: Low Density Lipoprotein (LDL) Management Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic Appropriate Treatment for Children with Upper Respiratory Infection (URI) Coronary Artery Disease (CAD): Beta-Blocker Therapy Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%) Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD) Efficient Use of Healthcare Resources Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD) Primary Open Angle Glaucoma (POAG): Optic Nerve Evaluation Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of Retinopathy Diabetic Retinopathy: Communication with the Physician Managing Ongoing diabetes Care Falls: Screening for Future Fall Risk Patient Safety Major Depressive Disorder (MDD): Suicide Risk Assessment Anti-depressant Medication Management 21

22 Appendix 2014 CQMs for Eligible Professionals (Cont.) CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain ADHD: Follow-up Care for Children Prescribed Attention-Deficit / Hyperactivity Disorder (ADHD) Medication Bipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance abuse Oncology: Medical and Radiation Pain Intensity Quantified Patient & Family Engagement Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer Patients Breast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor / Progesterone Receptor (ER/PR) Positive Breast Cancer Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Efficient Use of Healthcare Risk Prostate Cancer Patients Resources HIV/AIDS: Medical Visit HIV/AIDS: Pneumocystis jiroveci pneumonia (PCP) Prophylaxis 77 TBD (proposed HIV/AIDS: RNA control for Patients with HIV 0407) Preventive Care and Screening for Clinical Depression and Followup Plan Population / Public Health Documentation of Current Medications in the Medical Record Patient Safety Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Population / Public Health Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical Procedures Patient Safety Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery Pregnant women that had HBsAg testing Depression Remission at Twelve Months Depression Utilization of the PHQ-9 Tool 75 TBD Children who have dental decay or cavities 22

23 Appendix 2014 CQMs for Eligible Professionals (Cont.) CMS emeasure ID NQF # Measure/CQM Title National Quality Strategy Domain Child and Adolescent Major Depressive Disorder: Suicide Risk Assessment Patient Safety Maternal depression screening Population / Public Health 74 TBD Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists 61 TBD Preventive Care and Screening: Cholesterol Fasting Low Density Lipoprotein (LDL) Test Performed 64 TBD Preventive Care and Screening: Risk-Stratified Cholesterol Fasting Low Density Lipoprotein (LDL-C) 149 TBD Dementia: Cognitive Assessment 65 TBD Hypertension: Improvement in blood pressure 50 TBD Closing the referral loop: receipt of specialist report Care Coordination 66 TBD Functional status assessment for knee replacement Patient & Family Engagement 56 TBD Functional status assessment for hip replacement Patient & Family Engagement 90 TBD Functional status assessment for complex chronic conditions Patient & Family Engagement To see a full description of each measure, including the numerator and denominator statement, visit Guidance/Legislation/EHRIncentivePrograms/Downloads/EP_MeasuresTable_Posting_CQMs.pdf 23

24 Questions? Tracy McDonald Medicaid EHR Incentive Program Coordinator Phone:

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