Clinical Quality Measures (CQMs) and Physician Privileging

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Clinical Quality Measures (CQMs) and Physician Privileging A Leading Provider of Consulting and Systems Engineering Services to Public Health Organizations Introduction Clinical Quality Measures (CQMs) and Physician Privileging February 5, 2015

Overview CQM selection requirements for 2014 for Eligible Professionals and Hospitals EHR Reporting Options Physician Quality Reporting System (PQRS) Incorporating CQM outcomes with Physician Renewals or Privileges

2014 Clinical Quality Measures (CQMs) Eligible Professionals (EPs) are required to report 9 out of 64 measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEP.pdf Eligible Hospitals (EHs) are required to report 16 out of 29 measures http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CQM2014_GuideEH.pdf For both EPs and EHs, the quality measures selected must cover at least 3 of the 6 available National Quality Strategy (NQS) domains: Patient and Family Engagement Patient Safety Care Coordination Population/Public Health Efficient Use of Healthcare Resources Clinical Process/Effectiveness http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

EHR Reporting Options for EPs and EHs EHR Reporting Options for EPs in 2014: Options that only apply for the EHR Incentive Program Option 1: Attest to CQMs through the EHR Registration & Attestation System (https://ehrincentives.cms.gov/hitech/login.action) Option 2: eReport CQMs through Physician Quality Reporting System (PQRS) Portal Options that Align with Other Quality Programs Option 3: Report individual eligible professionals’ CQMs through PQRS Portal Option 4: Report group’s CQMs through PQRS Portal Option 5: Report group’s CQMs through Pioneer ACO participation or Comprehensive Primary Care Initiative participation EHR Reporting Options for EHs in 2014: Option 1: Attest to CQMs through the Registration & Attestation System Option 2: eReport through Hospital Inpatient Quality Reporting (IQR) http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2014_ClinicalQualityMeasures.html

Physician Quality Reporting System (PQRS) PQRS provides an incentive payment to practices with EPs (identified on claims by NPI and TIN), or group practices participating in the Group Practice Reporting Option (GPRO) who report data on quality measures for covered Medicare Physician Fee Schedule (PFS) services. Eligible Professionals: Medicare Physicians (Doctor of Medicine, Osteopathy, Dental, Oral Surgery, etc.) Practitioners (PA, NP, CRNA, CNS, CSW, etc.) Therapists (PT, OT, etc.) PQRS Reporting Methods: Medicare Part B claims Qualified PQRS registry Direct EHR CEHRT from Data Submission Vendor Qualified clinical data registry (QCDR) http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf

Incorporating CQM outcomes with Physician Privileges 1. Using NQF search criteria options and categories to structure renewals or privileges for a given EP: National Quality Strategy Priorities Affordable Care Effective Communication Patient Safety Person/Family Centered Care Care Setting Ambulatory Care Behavioral Health Hospital/Acute Care Facility Emergency Services Clinical Condition/Topic Area Cardiovascular Infectious Disease Neurology Prevention Data Source Administrative Claims Paper Medical Records Electronic Clinical Data EHR Labs Pharmacy Level of Analysis Clinician based Individual Team based Health Plan Facility Measure Type Composite Outcome Process 2. Using QRDA I and III reports for eCQMs chosen only 18% (or 42 measures) of NQF-endorsed measures are in eMeasure format QRDA I – patient specific QRDA III – population specific http://www.qualityforum.org/QPS

Incorporating CQM outcomes with Physician Privileges 3. Using PQRS components to structure renewals or privileges for a given EP or group: Factors considered when selecting specific measures Clinical conditions usually treated Types of care typically provided (e.g., preventive, chronic) Settings where care is usually delivered (e.g., emergency department, surgical suite) Quality improvement goals for 2014 Other quality reporting programs in use or being considered PQRS Outcomes Incentive Payments and Adjustments PQRS Feedback Reports Maintenance of Certification Program Value-based Payment Modifier Program Specialty Measure Sets for 2015 (suggested but not required) Cardiology (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Potential_Cardiology_Preferred_Specialty_Measure_Set.pdf) General/Family Practice(http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Potential_General_Practice_Family_Practice_Preferred_Specialty_Measure_Set.pdf) Radiology (http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/Potential_Radiology_Preferred_Specialty_Measure_Set.pdf)