Q & A with Premier: Implications for ecqms Under the CMS Update

Transcription

1 Q & A with Premier: Implications for ecqms Under the CMS Update Lori Harrington Senior Director, Quality and regulatory solutions Premier, Inc. Aisha Pittman Director, Quality policy and analysis Premier, Inc. May 19, 2016

2 Logistics No sound? Please dial from your phone to join the audio portion of the webinar. No sound will come through your computer speakers for the live event. Questions? Type them into the chat box (we ll address them at the end of the formal presentation) or ask them through the operator (after the presentation). Need reruns? This webinar is being recorded and will be forwarded via follow-up and posted in PremierConnect. 2

3 IPPS: ecqm Reporting Requirements FY 2016/2018 payment- Select 4 of 28 available ecqms Discharge Reporting Period Hospitals can report using either 2014 or 2015 edition of CEHRT Hospitals must submit via QRDA Category 1 Submission Deadline July 1, 2016 September 30, 2016 (Q3) February 28, 2017 October 1, 2016 December 31, 2016 (Q4) February 28, 2017 FY 2017/2019 payment Proposed- Report all 15 ecqms Discharge Reporting Period Submission Deadline Jan 1, 2017 December 31, 2017 February 28, 2018 Hospitals can report using either 2014 or 2015 edition of CEHRT for CY 2017 reporting/fy 2019 payment Must use 2015 edition of CEHRT for CY2018 reporting/fy2020 payment ecqm Validation (CY 2018 reporting/fy 2020 payment) Continue to select 600 hospitals for validation of chart-abstracted measures» Select additional 200 hospitals for validation of ecqms» Exclude hospitals selected for chart-abstracted measures» Exclude hospitals granted ECE exception for ecqms» Validation score based on timely submission of at least 75% of sampled ecqms, not accuracy 3

4 IQR ecqms Measure # Measure Name NQF# AMI-8a Primary PCI Received Within 90 Minutes of Hospital Arrival 0163 CAC-3 Home Management Plan of Care Document Given to Patient/Caregiver ED-1 Median Time from ED Arrival to ED Departure for Admitted ED Patients 0495 ED-2 Admit Decision Time to ED Departure Time for Admitted Patients 0497 EHDI-1a Hearing Screening Prior to Hospital Discharge 1354 PC-01 Elective Delivery (Collected in aggregate, submitted via Web-based tool or electronic clinical quality measure) 0469 PC-05 Exclusive Breast Milk Feeding 0480 STK-02 Discharged on Antithrombotic Therapy 0435 STK-03 Anticoagulation Therapy for Atrial Fibrillation/Flutter 0436 STK-05 Antithrombotic Therapy by the End of Hospital Day Two 0438 STK-06 Discharged on Statin Medication 0439 STK-08 Stroke Education STK-10 Assessed for Rehabilitation 0441 VTE-1 Venous Thromboembolism Prophylaxis VTE-2 Intensive Care Unit Venous Thromboembolism Prophylaxis 0372

5 IQR ecqms - Proposed for Removal in FY 2017/2019 Payment Measure # Measure Name AMI-2 Aspirin Prescribed at Discharge for AMI (NQF #0142) AMI-7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival AMI-10 Statin Prescribed at Discharge HTN Healthy Term Newborn (NQF #0716) PN-6 SCIP-Inf- 1a: Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients (NQF #0147) Prophylactic Antibiotic Received within 1 Hour Prior to Surgical Incision (NQF #0527) SCIP-Inf- 2a: Prophylactic Antibiotic Selection for Surgical Patients (NQF #0528) SCIP-Inf-9: Urinary Catheter Removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) with Day of Surgery Being Day Zero STK-4: Thrombolytic Therapy (NQF #0437) VTE-3: Venous Thromboembolism Patients with Anticoagulation Overlap Therapy (NQF #0373) VTE-4: VTE-5: VTE-6: Venous Thromboembolism Patients Receiving Unfractionated Heparin (UFH) with Dosages/Platelet Count Monitoring by Protocol (or Nomogram) Venous Thromboembolism Discharge Instructions Incidence of Potentially Preventable VTE Retain Chart-abstracted version 5

6 Hospital IQR Program Data Collection Measure Category CY 2016 Count Changes CY 2017 Count Chart-Abstracted 8 Remove 2 chart-abstracted 6 ecqms 28 4 Required Require All Remove Required HAI / NHSN 6 No change 6 30 day Mortality 6 No change 6 30 day Readmission 8 No change 8 AHRQ 2 No change 2 Hip/Knee Complications Efficiency 7 1 No change 1 Previously finalized to add 3 Propose to add 4 Structural 4 Remove 2 2 HCAHPS 1 No change 1 Totals 43 (68)

7 What are ecqms? ELECTRONIC CLINICAL QUALITY MEASURES Electronically calculated measure with a standardized CEHRT 4 ecqms required to submit for CY16 for CMS under the Inpatient Quality Reporting Program (IQR) 15 ecqms proposed to submit for CY17 for IQR. ecqms will continue to grow and will expand beyond single care settings ecqms are part of workflow and track performance of care provided are various episodes of care The HYBRID world will continue to exist for several years. 7

8 The New Gold Standard CMS is quickly transitioning to ecqms. TJC is gradually migrating to ecqms. NEW measures are created with e-specifications. Data is now clinically documented in electronic format opposed to paper charts. Electronic measures track a person not just the patient. Interventions rely on electronic measures. The ability to isolate financial and clinical gaps earlier in the care delivery process is crucial. 8

9 Joint Commission CY2016 Requirements For CY2016, hospitals have the option of selecting chart abstracted measures, all ecqm, or a combination of chart abstracted and ecqm. If electing to have a combination, members can have overlap of measures and have them count towards the required 6 measure sets. For example, can use both the IP ED chart abstracted measures (ED-1 and ED-2) and ecqm ED-1 and ED-2. This would be considered 2 measure sets. ecqms must be selected by measure set. If selected, ecqm data for either Q3 or Q must be submitted by March 15,

10 Current Challenges Meaningful Use requirements only require EHRs to have the capability to produce a QRDA file Not actually required to provide access to it or have it created. You may not have access to file as part of your existing EHR contract. You may never have gone through the exercise of mapping the data elements to the file. You may not have the latest version of EHR patches which includes necessary elements for measures. 10

11 Benefits of Working with Premier One Partner to satisfy reporting programs for: Submission of CMS Meaningful Use Clinical Quality Measures Submission of CMS IQR Clinical Quality Measures Submission of TJC measures (all options) One Partner for both chart abstracted and electronically calculated measures One Partner who aggregates your data, run reports, look system wide on performance when various facilities are at different stages of meaningful use readiness One Partner to centralize reporting for health systems with multiple EHRs in varying stages of meaningful use and data readiness The veteran Partner focused on Quality Improvement at its core not just a technology solution 11

12 Additional Considerations Premier calculates ecqms for all Eligible Providers as well. Leverage the one-stop organization that can provide cost and quality opportunities for all care givers regardless of care setting. Maximize your investment through a single source to aid in the collection, calculation, and submission of your measures while offering suggestions for improvements based on industry best practice. 12

13 What is a QRDA File? Quality Reporting Document Architecture A standard for communicating health care quality measurement information. It conforms to the requirements of HL7 CDA and will leverages HL7 CCD (consolidated clinical data). Clinical Documentation EHR base file QRDA File Data Element 1 Data Element 2 Data Element 3 Data Element 4 Data mapping Premier = Measures 13

14 Premier s Hospital Reporting Solution Unlimited amount of chart abstracted measures Up to 20 ecqms calculated Ability to see side by side comparisons of chart abstracted and electronically calculated measures View performance across the system regardless of EHR For ecqms, Data elements are pulled directly from the EHR Supports ALL CMS and TJC ecqm Reporting CMS Meaningful Use Inpatient Quality Reporting Program IQR The Joint Commission ORYX Core Measures» Advanced Certification programs as well American Heart Association GWTG State-based programs Includes Technical Readiness Assessment to evaluate accuracy of measures 14

15 Premier ecqm Implementation Process Readiness Assessment Implementation Run and Maintain Generate Data Capability Assessment Data Analysis Final report Member produces QRDA I files for analysis Premier validates format and data included in QRDA I Premier calculates measure results for all ecqm s and conducts deeper analysis for up to 4 ecqm s Premier prepares final results of assessment Member adjusts EHR as necessary Data Submission Setup Training Member / Premier establish cadence for submission of QRDA I Member / Premier setup application, including provisioning Premier provides training on ecqm reporting Data Submit Data Prep Data Reporting Regulatory Submission Member produces QRDA files and submits to Premier Premier calculates measure results Premier reports ecqm results via Quality Measures Reporter Member reviews results prior to Premier deadline for submission to regulatory agency 15

16 Technical Readiness Assessment The Readiness Assessment helps an organization identify the technical gaps that need to be closed to report desired measures and begin the transition to electronic data abstraction for ecqm reporting programs. Capability Assessment (3-4 weeks) Final Report (1-2 weeks) Data Analysis (3 weeks 3 months) Data is sourced from industry standard file format from Meaningful Use Stage 2 certified EHRs (Quality Reporting Data Architecture Type I, or QRDA I). Because of the technical nature of ecqms, the Readiness Assessment will involve individuals from Quality/Regulatory and IT teams. 16

17 Assessing EHR Capabilities Is the EHR is capable of reporting data for ecqm reporting? EHR s must be Meaningful Use Stage 2 to create QRDA I file More importantly, are there issues related to file specs/formats, missing data, etc.? Issues Affecting Ability to Submit: data cannot be submitted in its current state Issues Affecting Measure Accuracy: data can be submitted but may not be accurate Other Findings: regulatory submission can occur without issue, but may not meet requirements for other submissions or are not meeting expected standards 17

18 Our Recommendation Work needs to begin now, if it hasn t already. Assessment of ecqms can take months to ensure they are accurately captured. First Step - Understand current situation across each CCN Second Step Conduct assessment to test capabilities to produce ecqm results. Set goal to complete all assessments in 3 rd quarter 2016 Third Step - Implement by 4 th quarter to enable review of data that will be submitted before deadline in early

19 Please submit your questions now 19

20 Thank you for your time and attention! For more information please contact Premier s Solution Center at or solutioncenter@premierinc.com or Your Premier Field representative