The Alphabet Soup that is Clinical Quality Measure Reporting Initiatives

108 Pages·2016·4.82 MB·English

by  Ian Proffer

Data Repository Experts Since 1998
The Alphabet Soup that is
Clinical Quality Measure
Reporting Initiatives
Bill Presley, Vice President
Tuesday, May 31, 2016
Acronyms in this Presentation
ACA -Affordable Care Act OPPS -Outpatient Prospective Payment System
ASCQR -Ambulatory Surgical Center Quality Reporting OQR -Outpatient Quality Reporting
ARRA -American Recovery and Reinvestment Act PCCEC -Patient and Caregiver-Centered Experience of care/Care
Coordination
CEHRT -Certified Electronic Health Record Technology
PCHQR -PPS-Exempt Cancer Hospital Quality Reporting
eCQM-Electronic Clinical Quality Measures
VBP –Value-Based Purchasing
HAI -Healthcare-Associated Infection
HCAHPS -Hospital Consumer Assessment of Healthcare Providers
and Systems
IACS -Individuals Authorized Access to the CMS Computer
Services
IPFQR -Inpatient Psychiatric Facilities Quality Reporting
IPPS -Inpatient Payment Prospective System
IQR -Inpatient Quality Reporting
NHSN -National Healthcare Safety Network
MU –Meaningful Use EHR Incentive Program
Agenda
• Quality Payment Reporting Initiatives
• Clinical Quality Measure Alignment
• Compare and Contrast Reporting Requirements
• Proposed Programs
• Helpful Resources
CMS Guiding Principles
o Patient Centric
o Clinician Driven
o Simplification
Quality Payment Programs
CMS “All Seeing Eye”
Hospital Physician Quality
Quality Quality Payment
•EHR Incentive Program •EHR Incentive Program •Medicare Shared Savings
•PPS-Exempt Cancer Hospitals •Physician Quality Reporting Program
•Inpatient Psychiatric Facilities System (PQRS) •Hospital Value-Based
Purchasing
•Inpatient Quality Reporting •Value-Based Payment
•HAC payment reduction Modifier (VM) •Accountable Care
Organizations (ACO)
program •eRX Quality Reporting
•ESRD QIP
•Readmission reduction
program
•Outpatient Quality Reporting
•Ambulatory Surgical Centers
•The Joint Commission (TJC)
Vision for Quality Reporting
One Spec to rule them all, One Spec to find them,
One Spec to bring them all and in the darkness bind them
Vision for Quality Reporting
Unified and aligned set of clinical quality measures and
reporting requirements to synchronize and integrate CMS
quality programs which will reduce reporting burden and
improve on patient outcomes.
Quality Reporting Direction
The Future - One Specification
Core Measures Clinical Quality
(Chart Abstraction) Measure (eCQM)
•Manual Chart Abstracted •Electronically Captured
•Paper-based •Measure Concepts
specifications •Electronic Codification
•Translated to CMS •Electronic Specification
Specification Manual
•eCQM Library (One Spec)
Human vs Machine
Manual Abstraction Process
Manual
Manual
chart review
Patient Care interpreted
Capture Interpret by Calculate
documented results
abstraction
calculated
and coding
Human vs Machine
Electronic Measure Process
Data codified Electronically
Patient Care
Capture Codify and coding Calculate calculate and
documented
reviewed report