Dispatch from The Joint Commission (ORYX) Annual Vendor Briefing

I recently attended The Joint Commission's Annual Vendor Briefing for ORYX reporting vendors.

For those who are not familiar with The Joint Commission's (TJC) ORYX Program, it is a quality initiative program that embeds performance and outcome into its accreditation and certification processes. This allows Joint Commission accredited and certified organizations to be a part of ORYX quality improvement efforts.

Large hospitals participating in the ORYX quality program are required to submit quality measurement data with an ORYX vendor. Large hospitals defined by The Joint Commissions have an average daily census (ADC) of greater than 10 inpatients. ORYX chart-abstracted data is publicly reported on The Joint Commission website at Quality Check, www.qualitycheck.org.

TJC schedules their vendor briefing shortly after they publish their annual ORYX quality performance measures requirements. TJC and CMS hold an annual vendor briefing to review with ORYX vendors updates to quality measurement program for the following submission year. Members of the CMS quality reporting team attend the vendor briefing to review CMS quality programs as well. It's great The Joint Commission includes CMS at the vendor briefings.

Acmeware is a listed ORXY eCQM vendor. I've been attending the annual vendor briefing for the past two years and the most noticeable change I've seen is the increase in ORYX eCQM vendors. In addition, the topics and content over the past couple years have shifted from chart-abstraction to eCQM reporting.

CMS has come out many times in the past with CQM guidance indicating chart-abstracted reporting methods will be replaced with Electronic Health Record reporting using Electronic Clinical Quality Measures.  CMS indicted they are not putting new money into Core Measure reporting. All new work is going to eCQM development for reporting  outcomes and quality. CMS is pushing for EHRs at hospitals and this is direction of eCQMs. Currently, electronic reporting via EHR is required for IQR.  In the near future it will become more and more difficult for hospitals and providers to participate in IQR, OQR and PQRS without an EHR.

2017 Reporting and Submission Requirements
On September 7, 2016, The Joint Commission finalized the 2017 ORYX Performance Measurement requirements continuing their commitment to remain closely aligned with the CMS Hospital Inpatient Quality Reporting (IQR) Program.  Hospitals will be required to report on 6 of 13 available eCQMs applicable to the services provided and patient populations served by the hospital. In addition, hospitals will need to report 4 quarters of data for calendar year (CY) 2017 by the annual submission date (3/15/2018).

Significant Impact
In 2015, TJC provided hospitals with greater flexibility in meeting their 2015 ORYX performance measure requirements and to more closely align its quality reporting requirement with CMS. Hospitals had option to submit eCQMs, abstracted quality measures or a combination. In 2017, TJC reneged on the commitment to supporting all eCQMS and will now require hospitals to submit both Chart-Abstracted measures and eCQMs. This is a step backwards but we can discuss this at another time.

This year CMS and TJC presented great presentations on how their vision and strategy come together with clinical quality measurement and reporting. Some of the key points from the presentations.

The national landscape of quality measurement reporting is changing.

·         Focus has shifted from QI to accountability
·         Process of care measures are out
·         Outcomes are in, with claim-based outcome measurements
·         Patient-reported outcome performance measures are being used
·         Electronic Clinical Quality Measures (eCQMs) are replacing chart-based measures

Delivery System Reform
The first time in the history of the program CMS has explicit goals for alternative payment models and value-based payments are set for Medicare. CMS as set measurable goals and a timeline to move Medicare toward paying providers based on quality, rather than the quality of care. CMS has adopted a framework that categorized payments to providers.

Payment Taxonomy Framework
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

Comprehensive Care for Joint Replacement (CJR) Model
This program aims to support better and more efficient care for beneficiaries undergoing lower extremity joint replacements (LEJR). The model holds participant hospitals financially accountable for the quality and cost while incentivizing coordination of care among hospitals, physicians and post-acute care providers.

Joint Commission eCQMs
New eCQMs coming soon

De Novo eCQMs
·         Five (5) Patient Blood Management eCQMs
·         Four (4) Total Hip/Total Knee Replacement eCQMs

Re-Specified and Legacy
·         VTE-1 though VTE-6
·         STK-2 through STK-10
·         PC-01, PC-02, PC-05
·         CAC3
·         TOB-1 through TOB-3

Safe Use of Opioids
Electronic quality measure (eCQM) in development to address concerns associated with overlapping or concurrent prescribing of opioids .

Proposed Policy Changes
Time frames for preview period: publicly display data on Hospital Compare website, or other CMS website, as soon as possible after measure data have been submitted to CMS

What's up ahead
CMS has contracted with Mathematica Policy Research and its partners to develop, electronically specify, and maintain process and structural clinical quality measures for five CMS hospital quality programs. The programs are the Hospital Inpatient Quality Reporting Program, Hospital Outpatient Quality Reporting Program, Ambulatory Surgical Center Quality Reporting Program, Prospective Payment System–Exempt Cancer Hospital Quality Reporting Program, and Electronic Health Record (EHR) Incentive Program for Eligible Hospitals.

Measure Development in the pipeline
·         Total Hip & Total Knee Replacement
·         Acute Stroke Ready
·         Patient Blood Management
·         Comprehensive Cardiac Care Certification
·         Pediatric Imaging
·         Pain
·         Behavioral Health ED performance
·         PC companion measures (enhancing what we have)
·         Maternal hemorrhage

There are significant opportunities and challenges in 2017 and beyond with The Joint Commission requiring eCQM electronic submission using QRDA category 1 files.

Acmeware is well positioned to leverage our OneView reporting platform for hospital and provider reporting as CMS quality payment reporting programs and The Joint Commission align.

References
Payment Taxonomy Framework
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

Delivery System Reform
http://www.abms.org/media/84792/05-stephen-ondra_value-based-networkscompressed.pdf

Safe Use of Opioids
http://www.qualityforum.org/Electronic_Quality_Measures.aspx

Safe Use of Opioids eCQMs - IQR and OQR
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Downloads/Hospital-Inpatient-and-Outpatient-Process-and-Structural-Measure-Development-and-Maintenance.pdf

Dispatch from the MEDITECH Physician and CIO Forum 2016

Last month Acmeware was asked to attend and present at the 2016 MEDITECH Physician and CIO Form.

We had two very successful days at the forum, with a great table location right next to MEDITECH as you can see in the picture below.

The forum was well attended with a mix of CIOs, Providers, IT Informaticists, Quality Nurses, and CMIO's.

I was asked to speak with Jodi Frei on the downstream effects of quality reporting on revenue capture. Jodi and I took a detour from presenting the same quality reporting content that gets recycled on the web. We chose to present on the financial aspects of quality reporting that are tied to revenue capture.

The title of the presentation was Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting on Revenue Capture. In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.

View Presentation: http://www.slideshare.net/BillPresley/riding-the-rapids-of-payment-reform-downstream-effects-of-quality-reporting-on-revenue-capture

This is an exciting time in Healthcare and at Acmeware. Our new relationship with MEDITECH as a Collaborative Solutions vendor for Quality Measures and Joint Commission ORYX Reporting will expose our OneView quality reporting platform to more MEDITECH clients.

2017 is going to be an exciting year!

The Joint Commission shifting ORYX to eCQMs

The Joint Commission requires electronic clinical quality measure (eCQM) reporting for the ORYX Performance Measurement program in 2017

On September 7, 2016, The Joint Commission finalized the 2017 ORYX Performance Measurement requirements continuing their commitment to remain closely aligned with the CMS Hospital Inpatient Quality Reporting (IQR) Program. The Joint Commission has elected not to adopt all of the electronic clinical quality measures (eCQMs) implemented by CMS. The list of eCQMs The Joint Commission selected includes 13 of 15 eCQMs to be implemented by CMS.

For 2017, The Joint Commission has eliminated the measure set reporting requirement.  Measure selection and reporting will be by individual measure.

Summary of 2017 Joint Commission ORYX Measurement Requirements:

• Report on 5 required chart-abstracted measures quarterly.
• Hospitals with at least 300 live births will be required to report on all of the chart-abstracted perinatal care measures.
• Report on 6 of 13 available electronic clinical quality measures (eCQMs) by March 15, 2018.
• Performance measures must be submitted by a quality reporting vendor certified by The Joint Commission.
• Critical Access Hospitals (CAHs) and Small Hospitals (ADC ≤ 10) will report on a choice of 6 available measures.

Hospital Accreditation Program Requirements for ORYX

Electronic Clinical Quality Measures (eCQMs)

Hospitals will be required to report on 6 of 13 available eCQMs applicable to the services provided and patient populations served by the hospital. In addition, hospitals will need to report 4 quarters of data for calendar year (CY) 2017 by the annual submission date (3/15/2018).  Hospitals may elect to report on additional eCQMs relevant to services provided and patient populations served by the hospital – See The Joint Commission measures effective January 1, 2017.

The Joint Commission has finalized the following eCQMs:

• AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
• 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
• ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
• PC-01 - Elective Delivery
• PC-05 - Exclusive Breast Milk Feeding
• STK-02 - Discharged on Antithrombotic Therapy
• STK-03 - Anticoagulation Therapy for Atrial Fibrillation/Flutter
• STK-05 - Antithrombotic Therapy by the End of Hospital Day Two
• STK-06 - Discharged on Statin Medication
• VTE-1 - Venous Thromboembolism Prophylaxis
• VTE-2 - Intensive Care Unit Venous Thromboembolism Prophylaxis
• EHDI-1a - Hearing Screening Prior to Hospital Discharge

Chart-Abstracted Measures

Hospitals will need to report on 5 chart-abstracted measures applicable to the services provided and patient populations served by the hospital. Chart-abstracted measures must be collected and reported quarterly for calendar year (CY) 2017.  The Joint Commission has not adopted the CMS "sepsis management bundle" (SEP-1) and has removed STK-08 - Stroke Education, and STK-10 - Assessed for Rehabilitation from the measure selection.

The Joint Commission has finalized the following Chart-Abstracted Measures:

• ED-1 - Median Time from ED Arrival to ED Departure for Admitted ED Patients
• ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
• PC-01 - Elective Delivery
• VTE-6 - Incidence of Potentially Preventable VTE
• IMM-2 - Influenza Immunization Measure

Reporting on 4 additional Perinatal Care measures (PC-02, PC-03, PC-04, PC-05) is required for health care organizations with at least 300 live births per year.

• PC-01 - Elective Delivery
• PC-02 - Cesarean Section
• PC-03 - Antenatal Steroids
• PC-04 - Health Care-Associated Bloodstream Infections in Newborns
• PC-05 - Exclusive Breast Milk Feeding

Critical Access Hospitals and Small Hospitals for ORYX (ADC of 10 or fewer inpatients)

Electronic Clinical Quality Measures (eCQMs) / Chart-Abstracted Measures

Critical access hospitals and small hospitals must report on a total of 6 measures applicable to the services provided and patient populations served by the hospital from a combination of the finalized chart-abstracted measures and eCQMs below:

Chart-Abstracted Measures:

• ED-1, ED-2
• PC-01, PC-02, PC-03, PC-04, PC-05
• VTE-6
• IMM-2
• HBIPS-1, HBIPS-2, HBIPS-3, HBIPS-5
• TOB-1, TOB-2, TOB-3 SUB-1, SUB-2, SUB-3
• OP-18, OP-20, OP-21, OP-23

eCQM Measures:

• eAMI-8a
• eCAC-3
• eED-1, eED-2
• ePC-01, ePC-05
• eSTK-2, eSTK-3, eSTK-5, eSTK-6
• eVTE-1, eVTE-2
• eEHDI-1a

https://www.jointcommission.org/assets/1/18/2017_ORYX_Reporting_Requirements.pdf

Opportunities and Challenges

The Joint Commission requires that electronic clinical quality measures (eCQM) be submitted by a quality reporting vendor certified by the Joint Commission. Acmeware is an approved ORYX vendor for eCQMs. Acmeware continues to lead the way in clinical quality measure reporting and remains committed to working hospitals and physicians as they prepare for The Joint Commission ORYX Performance Measurement Reporting in their efforts to meet eCQM reporting requirements.

Last year, Acmeware was 1 of only six vendors submitted eCQMs to the Joint Commission on behalf of a hospital. This accomplishment demonstrates our long-term commitment to quality reporting and highlights why healthcare organizations are partnering with Acmeware to improve care quality and outcomes by using OneView as a single integrated quality reporting platform.

Trust is an important factor in determining an ORYX vendor partnership. As a trusted partner in Quality Reporting, Acmeware takes the responsibility of submitting ORYX measures to The Joint Commission.

2017 IPPS Rule Continues Commitment from Volume to Value Defined by eCQMs

CMS expands electronic clinical quality measure (eCQM) reporting in the Hospital IQR Program

On August 2, 2016, CMS issued a final rule continuing their commitment to eCQM reporting for the IQR program while increasingly shift Medicare payments from volume to value.
CMS believes that the use of certified EHRs can effectively and efficiently help providers improve internal care delivery practices, support the exchange of important information across care partners and during transitions of care, and enable the reporting of electronically specified clinical quality measures (eCQMs).

The rule finalized updates to multiple value-based care initiatives, such as the Hospital Inpatient Quality Reporting program, the EHR Incentive Program, the Hospital Value-Based Purchasing system, Hospital-Acquired Condition Reduction program, and Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP).  The final rule includes updates defined in the 2017 IPPS Proposed Rule. This summary will focus on Hospital Inpatient Quality Reporting program changes related to eCQMs, Chart-Abstraction and the EHR Incentive Program.

Hospital Inpatient Quality Reporting (IQR) Program:
CMS finalized the removal of 15 measures for the FY 2019 payment determination and subsequent years.  Of these 15 measures, 13 are electronic clinical quality measures (eCQMs), two of which CMS is also removing in their chart-abstracted form, and two others are structural measures.

Summary of changes:
• Removal of 13 eCQMs
• Submission of 8 self-selected eCQMs out of the available eCQMs for the CY 2017
• Requirement for annual submission of 4 quarters of eCQM data
• Required use of EHR technology certified to the 2014 or 2015 Edition of CEHRT for CY 2017 reporting period
• Required submission of eCQM data by the end of 2 months following the close of the reporting period calendar year

Electronic clinical quality measures (eCQM):
CMS has removed 13 eCQMs from both the Hospital IQR Program and the Medicare and Medicaid EHR Incentive Programs (Meaningful Use) in order for hospitals to focus on a smaller, more specific subset of eCQMs while keeping the programs aligned.
CMS finalized the removal of electronic versions of AMI-2, AMI-7a, AMI-10, HTN, PN-6, SCIP-Inf-1a, SCIP-Inf-2a, SCIP-Inf-9, VTE-3, VTE-4, VTE-5, VTE-6, and STK-4 beginning 
with the CY 2017 reporting period.



CMS has finalized the following eCQMs for 2017:
AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
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
ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
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)
PC-05 - Exclusive Breast Milk Feeding
STK-02 - Discharged on Antithrombotic Therapy
STK-03 - Anticoagulation Therapy for Atrial Fibrillation/Flutter
STK-05 - Antithrombotic Therapy by the End of Hospital Day Two
STK-06 - Discharged on Statin Medication
STK-08 - Stroke Education
STK-10 - Assessed for Rehabilitation
VTE-1 - Venous Thromboembolism Prophylaxis
VTE-2 - Intensive Care Unit Venous Thromboembolism Prophylaxis

In addition, CMS has finalized a number of changes in relation to eCQMs: 

1. Hospitals must report a full year, 4 quarters of data on an annual basis for 8 of the available eCQMs included in the Hospital IQR Program measure set starting in CY 2017 in order to align with the Medicare and Medicaid EHR Incentive Programs.
2. Requiring several related technical eCQM submission requirements beginning with the FY 2019 payment determination; and
3. Expanding the current validation process to include the validation of eCQM data beginning in the spring of CY 2018 for the FY 2020 payment determination.
4. The CMS has modified the existing validation process for the Hospital IQR Program data to include a random sample of up to 200 hospitals for validation of eCQMs

Chart- Abstraction:
The final rule includes removing two measures in their chart-abstracted forms STK-4 and VTE-5. The removal is a long-term effort to move quality measurement toward outcomes measures and electronic clinical quality measures. Hospitals must submit a full calendar year of data (covering Q1, Q2, Q3, and Q4) via chart-abstraction regardless of whether data also are submitted electronically in accordance with the applicable submission requirements. CMS has finalized the following chart-abstraction measure set:

CMS has finalized the following chart-abstraction measures:

ED-1 - Median Time from ED Arrival to ED Departure for patients Admitted ED Patients

ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients

Imm-2 - Influenza Immunization

PC-01 - Elective Delivery (Collected in aggregate, submitted via Web-based tool or electronic clinical quality measure)

Sepsis - Severe Sepsis and Septic Shock: Management Bundle (Composite Measure)

VTE-6 - Incidence of Potentially Preventable Venous Thromboembolism

Medicare and Medicaid EHR Incentive Programs:

CMS has finalized the following changes:

For manual attestation:

If only participating in the EHR Incentive Program, report on all 16 available CQMs.

For electronic reporting:

If only participating in the EHR Incentive Program, or participating in both the EHR Incentive Program and the Hospital IQR Program, report on 8 of the available CQMs

Penalties:

Hospitals that do not successfully participate in the Hospital IQR Program and do not submit the required quality data will be subject to a one-fourth reduction of the market basket update. Also, the law requires that any hospital that is not a meaningful EHR user will be subject to a three-fourths reduction of the market basket update in FY 2017.

CMS Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Final Rule Policy and Payment Changes for Fiscal Year (FY) 2017

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-18476.pdf

Navigating Healthcare Payment Reform

Path to Value: Navigating the New Normal in Healthcare Payment Reform; Quality Reporting through MACRA, MIPS, and VBP

The MACRA

CMS is transitioning to what they call "a new and more responsive regulatory framework." This new framework will be based on the landmark bipartisan legislation called MACRA. Medicare Access and CHIP Reauthorization Act (MACRA) signed into law on April 16, 2015 permanently repeals the Sustainable Growth Rate (SGR) formula for reimbursements enacted under the Balanced Budget Act of 1997. CMS's goal is "…electronic health records helping physicians, clinicians, and hospitals to deliver better care, smarter spending, and healthier people," said Patrick Conway, M.D., CMS deputy administrator for innovation and quality and chief medical officer.

Over the next couple years, we will see a transformation of fee for service into value-based care models driven by the Quality Payment Program, MACRA, Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM). Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.  Providers must find ways to improve the value of care they provide in a meaningful, measurable way. Providers will be responsible for their patient's cost and quality of care throughout the continuum of care, regardless of which providers actually deliver the service.

Below is a summary of the changes and the impact on organizations and providers.

MACRA ends Sustainable Growth Rate (SGR)

Starting in 2017! The MACRA proposal puts an end to the to the SGR for determining healthcare provider reimbursements. The new framework establishes a new system for providers rewarding better care not just more care. The new payment model framework officially starts in January 2019 based on your 2017 performance measures. This means 2017 performance measures and costs will determine your 2019 payment adjustments.

Affected clinicians are called “eligible clinicians” (EC) and will participate in MIPS. The types of Medicare Part B eligible clinicians affected by MIPS may expand in future years.

List of Eligible Clinicians under MIPS

Merit-based Incentive Payment System (MIPS)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the establishment of a Merit-based Incentive Payment System (MIPS) and consolidates certain aspects of a number of quality measurement and federal incentive programs for Medicare physicians and other providers into one more efficient framework.  MIPS was created to consolidate the disparate CMS incentive and penalty programs that exist today; Meaningful Use, PQRS, and VBM.

The separate payment adjustments that are determined under PQRS, Value Modifier, and Meaningful Use will all sunset as of Dec 31, 2018. Combining the existing quality reporting programs into one system, MIPS.

MIPS only applies to office-based physicians or other clinicians who are reimbursed by Medicare. It does not apply to hospitals, facilities, or Medicaid. The MIPS program will be administrated at the NPI level and will phase out TIN level requirements. Starting in 2017 reporting year, CMS will start with a small set of providers and starting in 2019, any provider with an NPI will be subjected to the MIPS program.

  

Currently there are multiple individual quality and value programs for Medicare physicians and practitioners where quality measurement reporting is tied to payments.

 

The future direction of quality reporting and payment reform will be scored on a scale of 0 to 100.

Total composite scoring is made of up of four weighted categories:

·         Quality (50%)

• 6 CQM measures selected by EC (Reduced from PQRS’s 9)
• 200 measures to select from – over 80% pertain to specialists

·         Advancing Care (25%)

• Emphasis on interoperability and information Exchange
• Eliminates “All or Nothing” scoring

·         Resource Use (10%)

• Pulls from Value Modifier
• Claims reporting on cost and quality

·         Clinical Improvement (15%)

• Care coordination, patient satisfaction, access measures

Consumers will be able to look at providers rated on MIPS performance and how they compare to their peers nationally. The level of transparency is far more than anything we have seen from CMS and with the current physician compare programs. MIPS simplifies the application of incentives and penalties for MU, PQRS, VBM programs while continuing to measures quality performance scoring as specified by each of the programs.

In response to a transition to quality measures, the CMS developed a standardized system for developing and maintaining the quality measures used in its various accountability initiatives and programs. The quality measures will be reviewed and finalized annually through a call for quality measures process. CMS has budgeted $75 MM for quality measure development as we move to EHR quality reporting.

Revenue at stake

Each category is weighted differently and every provider in the country will be scored. The mean or median of all providers will be determined and become the performance threshold. If the MIPS score exceeds the threshold then your Medicare part-b fee schedule will be higher than what's published, if it's below the threshold then your entire Medicare part-b fee schedule adjustment will be cut below published amount.

 

Advancing Care Information replaces Meaningful Use

Meaningful use of certified EHR technology is renamed to "Advancing Care Information" and the measure criteria is streamlined with emphasis on interoperability, information exchange and security measures. Clinical Decision Support and Computerized Provider Order Entry (CPOE) are no longer required. Advancing Care provides greater flexibility in meeting reporting requirements allowing physicians or clinicians to choose which best objective and quality measures fit their practice.

Beginning in 2017, physicians and other clinicians who currently participate in the Medicare Physician Meaningful Use program will no longer report or attest for this program and will instead report through MIPS. In 2017, eligible clinicians have the option of using a 2014 edition or 2015 edition certified technology. In 2018, eligible clinicians will be required to utilize 2015 edition certified technology and report on six Stage 3 measures.

Submission requirements for CY 2017:

·         Submission for full year, CY 2017, Objective Measures

·         Requires 2014 or 2015 Edition Certified EHR

·         Report on either (8) stage 2 or (6) stage 3 Advancing Care Information objectives and measures

·         Attest to cooperation with certain authorized IT surveillance and oversight activities

Opportunities and Challenges

As CMS moves to tie payments to outcomes, quality, value and practice improvement; organizations will need quality reporting and management tools to aggregate data from various source. Given efficiencies gained with electronic and consolidated reporting, organizations will have an opportunity to spend less time on patient data curation and interpretation and more time on developing strategies to positively impact actual patient outcomes. Clinical documentation improvement (CDI) will be a critical component of this transition to quality based reimbursement.  Without skilled clinical documentation and coding, organizations risk lost revenue.  Clinical documentation teams will identify ongoing documentation and coding opportunities that improve the clarity and medical necessity of services provided.  This will result in a more accurate reflection within the EHR of patient’s status and acuity level which will positively impact reimbursement. 

Organizations and providers will need to aggregate data from hospitals, physician clinics, home health agencies, skilled nursing facilities, providers, payers and patient devices for predictive and retrospective analytics to improve patient outcomes, quality and wellness.  Organizations will need quality reporting and management tools that can track and report populations of patients with specific conditions, perform concurrent review reporting, generate rules based alerting, and provide ad-hoc reporting for the patients care team.  Additional challenges include real time assessment of quality performance, identifying patients with alerts and actionable events who are falling outside the measure performance and tracking patients with chronic conditions.

Over the course of the year, the Quality Payment Program reporting requirements will evolve and the MACRA/MIPS reporting requirements will be finalized in the fall. As reporting requirements become more defined through law, we will be updating our blog content to reflect the changes.

In case you missed it, Jodi Frei, Manager of Clinical Informatics from Northwestern Medical Center, and I presented at the MEDITECH Nurse and Home Care Forum 2016 on strategies associated with electronic Clinical Quality Measure (eCQM) submission; we have archived the presentation for you In a Galaxy NOT So Far Far Away... eCQMs.

If you are attending the MEDITECH Physician and CIO Forum 2016 conference in October, Jodi and I will be presenting on clinical quality payment reporting. Looking forward to seeing you there.

- See more at: http://www.acmeware.com/posts/2016/july/navigating-healthcare-payment-reform

References

2016 Physician Quality Reporting System (PQRS): Understanding 2018 Medicare Quality Program Payment Adjustments

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Understand2018MedicarePayAdjs.pdf

Reuters. 27 February 2009. Retrieved 10 November 2015.

http://www.reuters.com/article/pressRelease/idUS193520+27-Feb-2009+BW20090227

The most important details in the SGR repeal law

https://www.advisory.com/research/health-care-advisory-board/blogs/at-the-helm/2015/04/sgr-repeal

The Medicare Access & CHIP Reauthorization Act of 2015 Path to Value

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

CMS has clarified that statement,

http://blog.cms.gov/2016/01/19/ehr-incentive-programs-where-we-go-next/

Dispatch from MUSE 2016

This past week I was at the 2016 International MUSE conference in Orlando Florida.

This year I was selected to present at three sessions, one Tuesday training workshop and two Thursday education sessions.

Acmeware was out in full force this year sponsoring the Executive Institute and presenting a total of 2 workshops and four education sessions.

I presented on a Tuesday training workshop titled the Alphabet Soup that is Clinical Quality Measure Reporting Initiatives. This was the second year we presented this topic and with all the changing requirement with CQMs, this should be a standard at MUSE over the next couple years.

I presented with Glen D'Abate, president of Acmeware, and Karen Arel, clinical informatics at a2z HIT, on a Thursday education sessions titled How to Successfully Submit eCQMs Electronically. We covered CQM measure selection, measures validation, nomenclature mapping and reporting once. Jodi Frei, Northwestern Medical Center in Vermont, and I co-presented on a Thursday workshop titled In a Galaxy NOT So Far, Far Away…eCQMs. We shared with everyone strategies Northwestern implemented for preparing for eCQMs. The education sessions were well attended and we received a lot of great feedback on the content. I would like to say thank you to Glen, Karen and Jodi for a great job with the presentations and help with the contact development.

On a side note, Jodi and I have been asked to present at MEDTIECH's 2016 Nursing and Home Care forum in Foxborough, MA from June 15-17 and at MEDTIECH's 2016 Physician and CIO Forum in Foxborough, MA from October 20-21. Looking forward to seeing everyone there.

Getting back to the conference, there wasn't a major theme this year like in the past with Meaningful Use and Interoperability.  Organization are starting to wind down from Meaningful Use and get back to the core parts of their business with revenue cycle, patient care and infrastructure maintenance.

Clinical quality payment reporting was still a big topic of discussion. Organization are trying to figure out how to prepare for eCQM reporting. I noticed a number of organizations still unclear how to manage value sets and nomenclature mapping. Acmeware is well positioned to educate and help organization with nomenclature mapping.

Looking back on last year's conference, there was a lot of excitement around MEDITECH's product roadmap. Last year MEDITECH’s Executive Vice President Hoda Sayed-Friel introduced MEDITECH as a platform (MaaP), native iPhone and Android support, managed applications from the App Store, and human genome genetic integration.

This year Hoda followed up with a great presentation on how their vision and strategy come together with product screenshots. Some of the themes from the product presentation.

Web:
The Web Acute and Web Ambulatory have a very nice user experience. The products are web-based, fully-integrated so as patients transition from ambulatory to acute there is a consistent look and feel with one user interface. This is an import feature because there are some many clinicians moving around providing coverage in different areas of the hospital, having a consistent user interface is important.

Mobile:
MEDITECH iPhone and Android apps will be available soon in the App Store and Google Play. Hospitals will be able to use smartphones and smart devices for servicing patient at the bedside. Clinicians will be able to draw blood with smart device and perform bedside medication verification and administrator medications. MEDITECH will be introducing various apps and devices to perform an overhaul in nursing.

Genetic Testing:
As I mentioned last year, MEDITECH is collaborating with genomic laboratories to integrate pharmacogenetics test results into clinical workflow to improve treatment, outcomes, disease management, wellness, patient safety and so much more.  This year, Hoda presented screenshot with genetic testing integration with examples of patients that would trigger alerts based on genetics tests.

Surveillance:
A new risk and surveillance product for flexible alerting based on key indicators. The surveillance and registry engine contain standard, pre-defined algorithms for alerting clinicians and patients running against catalogs to generate patient surveys for care communication.

Patient Engagement:
Patient engagement will be the new focus for MEDITECH. They demo'd some consumer facing products for continuous monitoring for preventive care. Patients have the ability to schedule video appointments that integrate directly into MEDITECH with video conferencing features so clinicians can perform virtual visits.

Business and Clinical Analytics:
MEDITECH will be bundling in BCA hundreds of standard reports that will eliminate the need for organizations to perform SQL programming and focus on patients. BCA will include home health monitoring integration with standard reports.

Historical Report Conversion:
In the past, MEDITECH did not provide complete conversion when migrating from MAGIC/CS/6.0 to 6.1. MEDTIECH will now be bundled conversion services into the base price. Hoda mentioned organizations will no longer need to provide historical backups for viewing archive report, MEDITECH will migrate content for all new installs.

There are significant opportunities in 2016: adding value to BCA Reporting with reporting integration services; historical reporting conversions with archive reporting; home health reporting and integration with Web Acute and Ambulatory; and  upgrades to 6.1, Web Acute and Web Ambulatory.

Overall, I left MUSE this year with feeling excited and optimistic. Acmeware is well positioned to leverage our OneView reporting platform for hospital and provider reporting as CMS quality payment reporting programs align.

2017 IPPS Proposed Rule fuels continued commitment to eCQM reporting for IQR

On April 18, 2016, CMS issued the 2017 IPPS proposed rule continuing their commitment to eCQM reporting for the IQR program. The rule proposes to continue a commitment to increasingly shift Medicare payments from volume to value. CMS has set goals and timelines to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they provide patients.

We are rapidly progressing toward value-based care models fueled by electronic clinical quality measure reporting. Healthcare organizations will no longer be motivated by implementing and meeting Meaningful Use, but instead will be driven by value-based care and risk-based payment models that focus on quality outcomes for reimbursements.

The proposed rule will require hospitals to report a full year, four quarters of data for all eCQMs included in the Hospital IQR Program measure set in 2017 and subsequent years in order to align with Medicare and Medicaid EHR Incentive Programs (Meaningful Use). CMS is also proposing to remove 15 measures for the CY 2017 reporting period and subsequent years. Of these 15 measures, 13 are electronic clinical quality measures (eCQMs), two of which CMS is also proposing to remove in their chart-abstracted form, and two others are structural measures. CMS is also proposing to refine two previously adopted measures beginning with the CY 2016 reporting period, the Hospital-level, Risk-standardized Payment Associated with a 30-day Episode-of-Care for Pneumonia and the Patient Safety and Adverse Events Composite.

In addition, CMS is proposing a number of changes in relation to eCQMs:
Require hospitals to submit all available eCQMs included in the Hospital IQR Program measure set for four quarters of data, on an annual basis, beginning with the CY 2017 reporting period.
To remove 13 electronic clinical quality measures (eCQMs) for the CY 2017 reporting period.
To modify the current validation process to include the validation of eCQM data beginning in the spring of CY 2018 reporting period.

Electronic clinical quality measures (eCQM):
CMS is proposing to remove the electronic versions of AMI-7a, HTN, PN-6, SCIP-Inf-9, VTE-3, VTE-4, VTE-5, VTE-6, STK-4, AMI-2, AMI-10, SCIP-Inf-1a, and SCIP-Inf-2a, beginning with the CY 2017 reporting period.

CMS is proposing to remove 13 eCQMs from both the Hospital IQR Program and the Medicare and Medicaid EHR Incentive Programs in order for hospitals to focus on a smaller, more specific subset of eCQMs while keeping the programs aligned.

CMS has finalized the following eCQMs:

• AMI-8a - Primary PCI Received Within 90 Minutes of Hospital Arrival
• 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
• ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
• 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)
• PC-05 - Exclusive Breast Milk Feeding
• STK-02 - Discharged on Antithrombotic Therapy
• STK-03 - Anticoagulation Therapy for Atrial Fibrillation/Flutter
• STK-05 - Antithrombotic Therapy by the End of Hospital Day Two
• STK-06 - Discharged on Statin Medication
• STK-08 - Stroke Education
• STK-10 - Assessed for Rehabilitation
• VTE-1 - Venous Thromboembolism Prophylaxis
• VTE-2 - Intensive Care Unit Venous Thromboembolism Prophylaxis

Chart- Abstraction:
The proposal includes removing two measures in their chart-abstracted forms STK-4 and VTE-5. The removal is because measure performance among hospitals is so high and unvarying that meaningful distinctions and improvements in performance can no longer be made.
Hospitals must submit a full calendar year of data (covering Q1, Q2, Q3, and Q4) via chart-abstraction regardless of whether data also are submitted electronically in accordance with the applicable submission requirements. CMS has finalized the following chart-abstraction measure set:

• ED-1 - Median Time from ED Arrival to ED Departure for patients Admitted ED Patients
• ED-2 - Admit Decision Time to ED Departure Time for Admitted Patients
• Imm-2 - Influenza Immunization
• PC-01 - Elective Delivery (Collected in aggregate, submitted via Web-based tool or electronic clinical quality measure)
• Sepsis - Severe Sepsis and Septic Shock: Management Bundle (Composite Measure)
• VTE-6 - Incidence of Potentially Preventable Venous Thromboembolism

The rule proposes updates to the Hospital-Acquired Condition Reduction Program, Hospital Readmissions Reduction Program and Hospital Value-Based Purchasing Program.

Hospital Acquired Conditions (HAC) Reduction Program:
CMS will continue to provide incentives for hospital to reduce the incidence of hospital-acquired conditions by making an adjustment to payments to hospitals that are in the worst performing quarterile for prevalence of hospital-acquired conditions. CMS is proposing to make five changes to existing HAC Reduction Program policies:

• Establish NHSN CDC HAI data submission requirements for newly opened hospitals;
• Clarify data requirements for Domain 1 scoring;
• Establish performance periods for the FY 2018 and FY 2019 HAC Reduction Programs;
• Adopt the refined PSI 90: Patient Safety for Selected Indicators Composite Measure (NQF # 0531); and 
• Change the Program scoring methodology from the current decile-based scoring to a continuous scoring methodology.

Hospital Readmissions Reduction Program (HRRP):
The HRRP requires a reduction to a hospital’s base operating DRG payment to account for excess readmissions associated with selected applicable conditions. CMS is proposing to update the public reporting policy so that excess readmission rates will be posted to the Hospital Compare website as soon as feasible following the hospitals’ preview period.

Hospital Value-Based Purchasing (VBP) Program:
The Hospital VBP Program adjusts payments to hospitals for inpatient services based on their performance on an announced set of measures. CMS proposes to expand the number of hospital units to which two National Healthcare Safety Network measures apply beginning with the FY 2019 program year. In addition, CMS proposes to expand the cohort used to calculate the 30-day pneumonia mortality measure beginning with the FY 2021 program year. CMS also proposes to add two condition-specific payment measures (one for acute myocardial infarction and one for heart failure) beginning with the FY 2021 program year and a 30-day mortality measure following CABG surgery beginning with the FY 2022 program year.

eCQM validation process: 
CMS believes that it is increasingly important to validate eCQM data to ensure the accuracy of future information submitted by hospitals and reported to the public. Therefore, CMS is proposing to adopt a validation process for eCQM data submissions beginning in spring of CY 2018. The proposed validation process will consist of eCQM data submitted by up to 200 hospitals selected via random sample.  If a hospital is selected for chart-abstracted targeted or random validation, that hospital would be excluded from the eCQM validation sample. Adding the proposed eCQM validation would result in a total of 800 hospitals in the validation process, as described in the below tables.



CMS will accept comments on the proposed rule until June 16, 2016, and will respond to comments in a final rule to be issued by August 1, 2016. The proposed rule can be downloaded from the Federal Register at: https://www.federalregister.gov/articles/2016/04/27/2016-09120/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the

- See more at: http://www.acmeware.com/posts/2016/april/2017-ipps-proposed-rule-for-iqr

Acmeware Successfully Completes eCQM Submissions for PQRS Partners

Another significant milestone reached for Acmeware and the OneView Hospital Quality and Physician Quality product.

I am excited to announce that we have successfully completed all submissions of Electronic Clinical Quality Measures (eCQM) for Meaningful Use and PQRS for MEDITECH acute care and ambulatory services using the OneView Physician Quality reporting product.

This success is a testament to the talent, dedication and commitment of the OneView project team given the aggressive timelines, multisystem interoperability requirements and the large volume of providers responsible for submitting eCQMs. We extend our sincere thanks to everyone who contributed to this success.

Our clients avoided the automatic PQRS and Value-Based Payment Modifier (VM) penalties by satisfying the submission requirements. In addition, this year we were able to reduce our client's financial costs associated with reporting individually for multiple CMS programs by aligning reporting requirements and streamlining their reporting efforts. We aligned Clinical Quality Measure reporting requirements across multiple programs to report quality data only once for PQRS and Meaningful Use.

The clinical workflow analysis and nomenclature mapping efforts completed during this project have created an opportunity to optimize Value-Based Payment Modifier (VM) Quality of Care composite scoring as we transition to the new value-base care reimbursement model with Medicare Access & CHIP Reauthorization Act (MACRA) and Merit-Based Incentive Payment System (MIPS).

Quality reporting of EHR data through the Electronic Clinical Quality measures (eCQM) system remains a strategic component for CMS in the transition to value-based care, the consolidation of PQRS, VBM and Meaningful Use with MACRA and MIPS. MIPS will sunset the PQRS, VBM and Meaningful Use penalties in 2018 creating a new composite score for judging incentives and adjustments. MIPS simplifies the application of incentives and penalties for PQRS, VBM and Meaningful Use while continuing to measure performance as specified by each of the three programs.

Acmeware continues to lead the way in clinical quality measure reporting and remains committed to working hospitals and physicians as they prepare for MACRA and MIPS in their efforts to meet eCQM reporting requirements. This accomplishment demonstrates our long term commitment to quality reporting and highlights why healthcare organizations are partnering with Acmeware to improve care quality and outcomes by using OneView as a single integrated quality reporting platform.

Trust is an important factor in determining a PQRS vendor partnership. As a trusted partner in Quality Reporting, Acmeware takes the responsibility of submitting PQRS measures to CMS through QualityNet. PQRS vendors are not required to submit CQM data, however, Acmeware offers to submit this data on behalf of all its partners at no cost as a value-added, concierge service.

Thank you for trusting Acmeware as your Clinical Quality Measure reporting partner. We look forward to continuing to be a trusted partner in Quality Reporting.

A Banner Day for Acmeware and the OneView Quality Product

It was a banner day for Acmeware and the OneView Hospital Quality and Physician Quality product.

I’m excited to announce that we have successfully completed our first submission of Electronic Clinical Quality Measure (eCQM) Sets to The Joint Commission  ORYX® Performance Measure program for Cortland Regional Medical Center. We successfully submitted eED-1 and eED-1 in QRDA Category 1 format to The Joint Commission. Acmeware has been an active participant in The Joint Commission  ORYX® Performance Measure program since we became an approved vendor by The Joint Commission last year.

My team has expert knowledge of electronica clinical quality measures and of the MEDTIECH EHR software. We have leverage the MEDITECH Data Repository to build an architecture that is highly scalability and reliability for utilizing both MEDTIECH and third party data for clinical quality measure reporting. As an exclusive MEDITECH reporting provider for hospitals and physicians, we are one of only a couple vendors who provide end to end software for clinical quality reporting with a unique data adapter that sites on top of the MEDITECH Data Repository (DR). We have a great relationship with the MEDITECH DR staff which I believe allows us to create an amazing experience for our OneView clients.

Trust is the most important factor in determining an ORYX vendor partnership. MEDITECH Hospitals must place a significant amount of responsibility on the ORYX vendor and product. ORYX vendors are required to submit hospital measure data to The Joint Commission.  If the ORYX vendor fails to submit data, they put the hospital at risk of failing to meet The Joint Commission Accreditation requirements, placing the hospitals accreditation status at risk.

As an ORYX vendor, Acmeware is expected to perform extensive data quality validation testing and address issues as part of the quarterly ORXY submission requirements. We are required to adhere to strict compliance criteria with the eCQM data to guarantee the QRDA Category 1 files (Hospital Clinical Data) accurately match what hospitals like Cortland Regional Medical Centers MEDITECH electronic health record is capturing. Further validation requires aggregate electronic population (ePop)  files to be reported from OneView to The Joint Commission in order to confirm the Hospital Clinical Data being reported is accurate. We perform intensive integrity checking prior to The Joint Commission submission to guarantee the accuracy of the population details and totals.

Acmeware continues to lead the way in clinical quality measure reporting and remains committed to working with The Joint Commission as they move toward alignment with the Centers for Medicare & Medicaid Services (CMS) and support accredited organizations in their efforts to meet eCQM reporting requirements.

As I highlighted in my 2015 year in review titled A Strategic Year for Acmeware and OneView Product Development, this accomplishment demonstrates our long term commitment to quality reporting and why healthcare organizations are partnering with Acmeware to improve care quality and outcomes by using OneView as a single integrated quality reporting platform.

I look forward to seeing what happens as organizations transition from chart-abstraction reporting to electronic clinical quality measures reporting and submission.