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
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
