Transcript clinical quality measures

CMS Final Rules:
Meaningful Use Criteria
VITL Webinar August 5, 2010
Tonya H. Howard, MSN, FNP-C
VITL Clinical Consultant
Today’s Objectives
• Covering rules only for Eligible Professionals
(EP’s)
• Brief overview of the Final Rules Meaningful
Use Criteria
• Look specifically at the Clinical Quality
Measures reporting requirements
• Recommended next steps
What Was
Changed?
• Changes based on
2000+ Comments
• Fewer requirements (20
vs. 25 for EP’s)
• Percentages required for
meeting compliance
lowered
• More clarity for some of
the rules
Stage I Meaningful Use
Objectives and
Measures
Overview
• 15 Objectives in the Core Set
• Reporting on 3 Core and 3 Selected Clinical
Quality Measures
• 10 “Menu” Objectives—select 5 to “defer”
• State may add up to 4 additional public health
objectives to list of core objectives
• “Structured Data”—in a data field with limited
or controlled entry possibilities; reportable,
exchange-able; NOT free text or narrative
Health Outcomes Priority: Improve quality,
safety, efficiency, reduce health disparities
1. CPOE (Computerized Physician Order Entry)
for medication orders (>30%)
2.Implement drug-drug and drug-allergy
interaction checks (Function enabled? Yes or
No)
3.ePrescribing (>40%)
4.Record demographics (including Language,
Race, Ethnicity) (50%)
Health Outcomes Priority: Improve quality,
safety, efficiency, reduce health disparities
5. Up-to-date problem list of current and active
diagnoses (>80%)
6. Maintain active medication list (>80%)
7.Maintain active medication allergy list (>80%)
8.Record and chart changes in vital signs: (>50%)
– Height, Weight, BP
– BMI for Adults
– Plot and Display BMI for Children
Health Outcomes Priority: Improve quality,
safety, efficiency, reduce health disparities
9. Record smoking status for patients 13 and
older (>50%)
10. Implement one clinical decision support
rule with ability to track compliance with
that rule (Implented? Yes or No)
11. Report ambulatory clinical quality measures
to CMS or the States (Provide numerator,
denominator, and exclusions in 2011 2012
electronic submission)
Health Outcomes Priority: Engage Patients
and Families in their Health Care
• 12. Provide patients with an electronic copy
of their health information within 3 days(e.g.,
CD, Flash Drive, Web Portal, etc. (>50%)
–
–
–
–
Diagnostic test results
Problem List
Med List
Med Allergies
• 13. Clinical summaries for pts for each office
visit within 3 days(>50%)
Health Outcomes Priority:
Improve care coordination
14. Capability to exchange key clinical
information among providers and patient
authorized entities electronically (one test
of capacity of EHR to exchange
information)
Health Outcomes Priority:
Ensure adequate privacy and
security protections for PHI
15. Privacy and Security Risk Analysis
(address risks)
Menu Set of Stage 1 Objectives:
Choose 5 to eliminate
1. Drug-formulary checks
2. Lab results as structured data
3. Generate lists of patients by condition
4. Send reminders per patient preference for
preventive/follow-up care
5. Patient access to health information within 4
days
Menu Set of Stage 1 Objectives:
Continued
6. Electronic patient education/Resources
7. Medication reconciliation
8. Provide summary of care record
9. Submit data to immunization registries*
10. Submit syndromic surveillance data to*
public health
3 Core Measures**
o Hypertension: BP recorded
o Tobacco Use Assessment
and Cessation Intervention
o Adult Weight Screening
and Follow-up
Clinical
Quality
Measures
Reporting
**If you do not have
patients for whom one or
more of these measures
applies, the measure(s)
may be substituted for an
Alternate Core Measure
(e.g., Pediatrics)
3 Alternate Core Measures
o Weight Assessment and
Counseling for Children and
Adolescents
o Influenza Immunization for
Patients > 50 y/o
o Childhood Immunization
Status
Clinical
Quality
Measures
Reporting
3 Selected Measures
from a list of 38 (vs. 90
in the preliminary
rules—no longer
divided by specialty)
Clinical
Quality
Measures
Reporting
CQM: Additional Set for EP’s
1. Diabetes: Hemoglobin A1C poor
control
2. Diabetes: LDL Management and
Control
3. Diabetes: BP Management
4. Heart Failure: Ace/ARB Rx for LVSD
5. CAD: Beta Blocker for prior MI
6. Pneumonia Vaccination for Older
Adults
7. Breast CA screening
8. Colorectal Cancer screening
9. CAD: Oral Antiplatelet Rx
10. Heart Failure: Beta Blocker for
LVSD
11. Anti-depressant medication
mgmt
12. Primary Open Angle Glaucoma
(POAG): Optic Nerve Evaluation
13. Diabetic Retinopathy:
Documentation of presence or
absence of Macular Edema and
Level of Severity of Retinopathy
14.Diabetic Retinopathy:
Communication with Managing
Physician
15.Asthma Pharmacologic Therapy
16.Asthma Assessment
17.Appropriate testing for children
with pharyngitis
18.Oncology Breast Cancer:
Hormonal Tx for
Estrogen/Progesterone Receptor
Positive CA
CQM: Additional Set for EP’s
(Cont’d)
19. Oncology Colon Cancer: Chemo
for Stage III CA patients
20. Prostate CA: Avoid overuse of
Bone Scan for Staging Low Risk
pts
21. Smoking and Tobacco Use
Cessation, Medical Assistance
22. Diabetes: Eye Exam
23. Diabetes: Urine screening
24. Diabetes: Foot Exam
25. CAD: Statin Rx for lowering LDL
26. Heart Failure: Warfarin for A-Fib
27. IVD: BP Management
28. IVD: Use of ASA/Antiplatelet
29. Initiate ETOH/Drug Abuse Tx
30. Prenatal Care: Screening for HIV
31. Prenatal Care: Anti-D Immunoglob
32. Controlling High BP
33. Cervical Cancer Screening
34. Chlamydia Screening for Women
35. Use of Appropriate Meds for
Asthma
36. Low Back Pain: Use of Imaging
Studies
37. IVD: Complete Lipid Panel and LDL
Control
38. Diabetes: HBA1C Control (<8.0%)
Stage 1: Reporting Requirements
Hypertension
Tobacco use
Adult weight
15 Core
Objectives
3 core
State can
move 4 from
menu to core
CMS/State
or 3 alternate
3 additional
10 Menu Set
Objectives
8/5/2010
1 must be
public health
measure
44Clinical
Quality
Measures
PQRI/NQF
Measures
Alternate: Children Weight
Flu Immunization > 50 yrs
Children Immunization
VITL
19
Meaningful Use Assessment Tool
Will be available on the VITL website in the
next few days