Using Quality Reporting and Health Information Technology to Improve Patient Care. Thursday, April 21, 2016 David Smith Acumentra Health

Transcription

1 Using Quality Reporting and Health Information Technology to Improve Patient Care Thursday, April 21, 2016 David Smith Acumentra Health

2 Good Afternoon David Smith HIT Project Coordinator Acumentra Health

3 Importance of Feedback CMS Feedback Loop Local Payer/Contractor Feedback Loop System loop Provider Loop

4 This Presentation Applies to Outpatient office 2. Hospital 3. Home health setting 4. Skilled nursing facility 5. Pharmacy 6. Laboratory 7. Call center 8. Other 9. Payer 10. Health care system 11. IPF/behavioral health 12. State and local health departments

5 Objectives Learn how to interpret and leverage quality measure reports for internal process improvement Learn how to effectively document patient care in electronic systems Understand how health information technology tools can support process improvement and patient engagement

6 Provider Feedback Loop Provider Feedback Loop 1. Document (how is it calculated?) 2. Report on data 3. Leverage data for improvement

7 Where Do You Get Your Quality Reports From? 1. Outpatient Office: EHR, Payer Data, ACO, Analysts 2. Hospital: QI Department, Payers, Dashboards 3. Home Health Setting: Admin Office, Claims, OASIS/CASPER 4. Skilled Nursing Facility: Admin Office, Claims 5. Pharmacy: Marketing Lists (Flu Shots) 6. Imaging: PACS, EHR, HIE 7. Laboratory: LIS System, HIS System 8. Payer: HEDIS Measurement HIE Population Health 9. ASC: Claims Data, EHR System 10. IPF: Claims Data, EHR System, HIE 11. Health Care System All of the Above

8 Interpreting and Leveraging Quality Measures Input: Get the data into the right place Output: Use frequent feedback reports to communicate improvement/ensure accurate documentation Document notable changes in process Utilize interoperability to enhance documentation Lab E-referral/HIE Record reconciliation Indexing process on inbound paper/fax

9 Poll: What areas would you rate as most difficult in documenting patient care? (1) variation in documentation and communication (2) the absence of a centralized care overview in the patient's electronic health record, i.e., easily accessible by the entire care team (3) rarity of interdisciplinary communication

10 Documenting Patient Care Challenges to a nurse (1) variation in nurse documentation and communication (2) the absence of a centralized care overview in the patient's electronic health record, i.e., easily accessible by the entire care team (3) rarity of interdisciplinary communication Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information. sb-search=documenting+patient+care&sbinst=3_dnn_avtsearch&sb-logid=9976-posmg6g7wcuwj9ch

11 Documenting Patient Care Solutions (1) Be consistent (2) Make the care plan accessible to the whole team (3) Communicate across teams Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information.

12 *Consistency in Documentation Document consistently Submit that measurement will help you be consistent Understand how your care is measured Where to document Request frequent/immediate access to feedback/reports Understand the multitude of ways a particular measure as it relates to care is measured

13 Urine Protein Screening Urine Protein Screening for Diabetics Measure How many ways can you measure this? Electronic CQM in many EHR systems Including hospital/pqrs

14 Quick Review, What You re Measuring For diabetes patients, we re measuring whether or not the patient has had a urine test, which also includes whether or not they had screening or evidence of nephropathy Exact denominator and numerator examples to follow

15 Denominator Example Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included Patients years of age with diabetes and a visit during the measurement period

16 Denominator Inside Your EHR Age/Time Period/Type of Visit Initial Population = AND: Age >= 18 year(s) at: "Measurement Period" AND: Age < 75 year(s) at: "Measurement Period" AND: "Diagnosis, Active: Diabetes" overlaps "Measurement Period" AND: Union of: "Encounter, Performed: Office Visit" "Encounter, Performed: Face-to-Face Interaction" Clinic, Hospital, Skilled Nursing Facility "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" "Encounter, Performed: Home Health Care Services" Home Health "Encounter, Performed: Annual Wellness Visit" Clinic during "Measurement Period"

17 Details - OIDs Data Criteria (QDM Data Elements) "Diagnosis, Active: Diabetes" using "Diabetes Grouping Value Set ( )" "Diagnosis, Active: Diabetic Nephropathy" using "Diabetic Nephropathy Grouping Value Set ( )" "Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" using "Glomerulonephritis and Nephrotic Syndrome Grouping Value Set ( )" "Diagnosis, Active: Hypertensive Chronic Kidney Disease" using "Hypertensive Chronic Kidney Disease Grouping Value Set ( )" "Diagnosis, Active: Proteinuria" using "Proteinuria Grouping Value Set ( )" "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit Grouping Value Set ( )" "Encounter, Performed: ESRD Monthly Outpatient Services" using "ESRD Monthly Outpatient Services Grouping Value Set ( )" "Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set ( )" "Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services Grouping Value Set ( )" "Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set ( )" "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up Grouping Value Set ( )" "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up Grouping Value Set ( )" "Intervention, Performed: Dialysis Education" using "Dialysis Education Grouping Value Set ( )" "Intervention, Performed: Other Services Related to Dialysis" using "Other Services Related to Dialysis Grouping Value Set ( )" "Laboratory Test, Performed: Urine Protein Tests" using "Urine Protein Tests Grouping Value Set ( )" "Medication, Active: ACE Inhibitor or ARB" using "ACE Inhibitor or ARB Grouping Value Set ( )" "Procedure, Performed: Dialysis Services" using "Dialysis Services Grouping Value Set ( )" "Procedure, Performed: Kidney Transplant" using "Kidney Transplant Grouping Value Set ( )" "Procedure, Performed: Vascular Access for Dialysis" using "Vascular Access for Dialysis Grouping Value Set ( )"

18 Numerator Example Patients with a screening for nephropathy or evidence of nephropathy during the measurement period Not just a urine screening

19 Numerator Inside Your EHR Count the Methods for Numeration! Numerator = AND: OR: Union of: 1. "Medication, Active: ACE Inhibitor or ARB" 2. "Diagnosis, Active: Hypertensive Chronic Kidney Disease" 3. "Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" 4. "Diagnosis, Active: Diabetic Nephropathy" 5. "Diagnosis, Active: Proteinuria" overlaps "Measurement Period" OR: Union of: 6."Procedure, Performed: Kidney Transplant" 7. "Procedure, Performed: Vascular Access for Dialysis" 8. "Procedure, Performed: Dialysis Services" 9. "Intervention, Performed: Other Services Related to Dialysis" 10. "Intervention, Performed: Dialysis Education" 11. "Encounter, Performed: ESRD Monthly Outpatient Services" 12. "Laboratory Test, Performed: Urine Protein Tests (result)" during "Measurement Period"

20 Your Role in Quality Numerator = AND: OR: Union of: 1. "Medication, Active: ACE Inhibitor or ARB" [Pharmacy] 2. "Diagnosis, Active: Hypertensive Chronic Kidney Disease" 3. "Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" 4. "Diagnosis, Active: Diabetic Nephropathy" 5. "Diagnosis, Active: Proteinuria" overlaps "Measurement Period" OR: Union of: 6."Procedure, Performed: Kidney Transplant" [Hospital HIE Discharge Messaging] 7. "Procedure, Performed: Vascular Access for Dialysis" [Dialysis Center] 8. "Procedure, Performed: Dialysis Services" [Referral to Dialysis Center] 9. "Intervention, Performed: Other Services Related to Dialysis" [Referral Education - ] 10. "Intervention, Performed: Dialysis Education" [- Diabetes Educator Referral Education] 11. "Encounter, Performed: ESRD Monthly Outpatient Services" [ESRD Network referral/closed loop] 12. "Laboratory Test, Performed: Urine Protein Tests (result)" during "Measurement Period" [ Clinic - Lab]

21 Details - OIDs Data Criteria (QDM Data Elements) "Diagnosis, Active: Diabetes" using "Diabetes Grouping Value Set ( )" "Diagnosis, Active: Diabetic Nephropathy" using "Diabetic Nephropathy Grouping Value Set ( )" "Diagnosis, Active: Glomerulonephritis and Nephrotic Syndrome" using "Glomerulonephritis and Nephrotic Syndrome Grouping Value Set ( )" "Diagnosis, Active: Hypertensive Chronic Kidney Disease" using "Hypertensive Chronic Kidney Disease Grouping Value Set ( )" "Diagnosis, Active: Proteinuria" using "Proteinuria Grouping Value Set ( )" "Encounter, Performed: Annual Wellness Visit" using "Annual Wellness Visit Grouping Value Set ( )" "Encounter, Performed: ESRD Monthly Outpatient Services" using "ESRD Monthly Outpatient Services Grouping Value Set ( )" "Encounter, Performed: Face-to-Face Interaction" using "Face-to-Face Interaction Grouping Value Set ( )" "Encounter, Performed: Home Health Care Services" using "Home Health Care Services Grouping Value Set ( )" "Encounter, Performed: Office Visit" using "Office Visit Grouping Value Set ( )" "Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up" using "Preventive Care Services - Established Office Visit, 18 and Up Grouping Value Set ( )" "Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up" using "Preventive Care Services-Initial Office Visit, 18 and Up Grouping Value Set ( )" "Intervention, Performed: Dialysis Education" using "Dialysis Education Grouping Value Set ( )" "Intervention, Performed: Other Services Related to Dialysis" using "Other Services Related to Dialysis Grouping Value Set ( )" "Laboratory Test, Performed: Urine Protein Tests" using "Urine Protein Tests Grouping Value Set ( )" "Medication, Active: ACE Inhibitor or ARB" using "ACE Inhibitor or ARB Grouping Value Set ( )" "Procedure, Performed: Dialysis Services" using "Dialysis Services Grouping Value Set ( )" "Procedure, Performed: Kidney Transplant" using "Kidney Transplant Grouping Value Set ( )" "Procedure, Performed: Vascular Access for Dialysis" using "Vascular Access for Dialysis Grouping Value Set ( )"

22 Urine Protein Screening Urine Protein Screening for Diabetics Measure How many ways can you measure this?

23 Get Feedback How often do you get feedback/information? Every 2 Years? Every Year Quarterly Monthly Daily?

24 Make the Care Plan Accessible to the Who might you share the care plan with? Whole Team

25 Make the Care Plan Accessible to the Care Team Primary Care Provider Specialist Patient Guardian Hospital ASC Home Health ESRD Whole Team

26 Mechanisms that Support Sharing the Care Plan Mechanisms EHR HIE Direct Messaging Patient Portal Fax Letter

27 Mechanisms that Support Sharing the Patient Portal Patient can access Guardians can be granted access to a patient s portal Care Plan

28 Mechanisms that Support Sharing the Care Plan Direct Messaging Clinician to facility Clinician to clinician

29 Mechanisms that Support Sharing the HIE Sharing current care plan to the HIE can support better interoperability with care team members also accessing HIE Care Plan

30 Measurement Government Reporting Clinic - PQRS ecqms Hospital Reporting ASC Home Health Skilled Nursing Facility Others

31 Reports Opportunity Prevention/Coordination Use quality reports in care coordination Provide reports to care coordinators/ma/panel managers to bring in patients for care Use patient portal for reminders/patient care Acute Quality Improvement Discharged patients hospitals reminding clinics/sending reports Identifying errors/opportunities for improvement

32 Sample Report

33 Sample Drill Down/Detail Report

34 Sample Drill Down/Detail Report

35 Noting Communication Options Phone Patient Portal Connection Text Patient Portal

36 Communications Preferences

37 Interactive Electronic Prevention Reminders SEND REMINDER OF FLU SHOT

38 Coordination Report Phone

39 Received Message in Patient Portal

40 Received Message in Guardian s Portal

41 Point of Care Decision Support Diabetes Flowsheet/Health Maintenance/Alert System Date Lab/data Measurement 1/1/2016 a1c 9 1/1/2016 urine test 270 µg/mg creatinine 1/1/2016 Retinopathy + (referred)

42 Other Setting Examples: Hospital Admit to Departure ASC 7 Day Risk Hospitalization Rate

43 Hospital Example: CMS ED-2 Throughput Median time (in minutes) from admit decision time to time of departure from the emergency department for emergency department patients admitted to inpatient status

44 Measure Definition Denominator: Inpatient encounters ending during the measurement period with length of stay (discharge date minus admission date) less than or equal to 120 days Numerator Time (in minutes) from decision to admit to ED discharge for patients admitted to the facility from the emergency department

45 Areas Referring Back to Nurse Documentation Example Consistent Documentation Admit/discharge Care Plan Create and share on discharge w/patient and primary care provider Interdisciplinary Communication Share discharge w/community via fax or HIE

46 Colonoscopies ASC Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy Measure Methodology Data Source: CMS calculates the measure using Medicare claims data submitted by facilities. Measure Population: The measure includes Medicare fee-for-service (FFS) beneficiaries age 65 years or older who underwent an eligible, low-risk colonoscopy at an OPD, ASC or in a physician office. The measure calculations for the 2015 dry run include eligible colonoscopies that were performed during a three year period from July 1, 2011 through June 30, The measure calculation for the dry run combines data from all facilities with eligible colonoscopies in one calculation. Measure scores are reported only for ASCs and OPDs. Outcome: The measure counts unplanned hospital visits (defined as emergency department visits, observation stays and inpatient admissions) for all causes within 7 days after the eligible colonoscopy procedure. Risk Adjustment: The measure adjusts for patient case mix differences across facilities. How many Sources involved potentially: HIE/ASC/Medicare/Hospital/Clinic Other measures affected CDIF

47 Summary Objectives Learn how to interpret and leverage quality measure reports for internal process improvement Reviewed detailed requirements involved for tracking quality measurement Reviewed importance of frequent feedback for improvement Learn how to effectively document patient care in electronic systems Reviewed complexity of examples from clinic/home health/hospital/asc Understand how health information technology tools can support process improvement and patient engagement Reviewed importance of feedback How to create measurement reports Use them to dive into details for coordination

48 ACTION Chat In the chat box: Name one area you heard about today that you can go to work on in your organization in the next two weeks GO!

49 Let Us Help You in Your Setting New Mexico Nevada Oregon Acumentra Health, affiliate of HealthInsight Utah

50 Upcoming Change Agent Events Planning Ahead for the Next Reporting Cycle Thursday, May 12, 2016 Noon-1 MT/11-Noon PT For more information on this webinar and upcoming events, visit our website at

51 Thank You David Smith, MBA HIT Project Manager This material was prepared by HealthInsight, the Medicare Quality Innovation Network -Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-CORP-16-31