Electronic Health Records

Adoption & Implementation News

Updated Clinical Quality Measures Revealed by CMS

By Vera Gruessner

Eligible hospitals and healthcare professionals looking to meet meaningful use requirements and obtain financial incentives from the Medicare and Medicaid EHR Incentive Programs will need to keep track of electronic clinical quality measures (eCQMs), which are part of clinical quality reporting programs such as the Physician Quality Reporting System (PQRS).

Today the Centers for Medicare & Medicaid Services (CMS) announced the annual update for the 2014 electronic clinical quality measures. Healthcare providers will need to utilize these updated measures to report 2016 quality data electronically for CMS quality reporting programs. These programs include PQRS, the EHR Incentive Programs, and the Inpatient Quality Reporting Program (IQR).

EHRIntelligence.com recently spoke with William O’Byrne, Executive Director of NJ-HITEC, to learn more about their PQRS data registry and how it helps providers successfully submit the data necessary to reach pay-for-value measures and meaningful use provisions.

“In the past, payment structures have always been based on the number of services that physicians provide. If they do 20 things in one appointment, then they get paid for 20 different things or they get a bundled payment,” O’Byrne said. “CMS has decided and are now implementing a whole new way of paying doctors and hospitals for healthcare. It’s called Pay for Value. No longer will doctors be paid for adding up many different things they did during a visit.”

“They will now have to track clinical quality measures, which are the same thing that’s in the PQRS,” O’Byrne stated. “They will also have to show that there’s a change for the better in clinical quality measures. They will get paid for value instead of for individual items. The registry is the way that CMS is going to be determining how well or how badly the doctor is doing in the delivery of healthcare.”

The reason CMS updates quality measures on an annual basis is to keep the specifications in agreement with modern clinical guidelines along with code systems. These measures need to stay pertinent and actionable within the current healthcare setting.

To keep track of the updated clinical quality measures, visit the CMS website to find 64 updated measures for eligible clinicians and 29 updated measures for eligible hospitals.QDM 4.1.2 based-HQMF version R 2.1 was used to re-specify each of the 2015 updated measure specifications.

To access the clinical quality measures for the 2014 EHR Incentive Programs, eligible professionals should click here. For more guidance on implementing the May 2015 electronic clinical quality measure specifications, eligible hospital providers and eligible healthcare professionals may benefit from the CMS Electronic Clinical Quality Measure Logic and Implementation Guidance.

The guidance offers a variety of information on the types of electronic clinical quality measures including patient-specific measures, episode-of-care measures, proportion measures, and continuous variable measures. Some of the measures include screening for clinical depression, screening for high blood pressure, HIV/AIDS treatments, assessment for complex chronic conditions, cancer screenings, diabetes foot examination, and medication management.

Through the CMS eCQM library, providers can download the whole set of measures in their relevant zip files. The Value Set Authority Center is also a useful resource, as it offers a simple way to download value sets for the eCQMs in multiple file formats. The value sets can be accessed as sets per measure or as a whole, unified set. Additionally, the Data Element Catalogue includes the complete list of 2014 eCQMs and value set names, CMS reported.





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