- Since launching the Meaningful Measures initiative in 2017, CMS has been adamant about only including electronic clinical quality measures (eCQMs) in federal reporting programs that evaluate core issues most vital to high-quality care delivery and improved patient health outcomes.
CMS put the principles of this initiative into practice in the recently-released Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System final rule.
In total, the final rule removes 18 quality measures from reporting programs and de-duplicates another 25 measures.
“CMS updated the number of measures required for each of these programs after engaging in a careful and holistic review of all the quality measures and seeking input from various stakeholders through the public comment process,” wrote CMS in the 2019 IPPS/LTCH final rule fact sheet.
“Measures were proposed for removal if they met the criteria for removal under one of the measure removal factors that CMS had either adopted previously or was proposing to adopt in the proposed rule,” the federal agency continued.
In accordance with stakeholder feedback, CMS maintained quality measures related to patient safety. Meanwhile, the federal agency removed measures that were duplicative, showed no meaningful distinction in performance, or were overly costly to maintain and report compared with their benefit to care quality.
The decision to adopt criteria for removal that eliminates measures if they are more costly to report than beneficial to the program is a new addition CMS implemented in the IPPS final rule.
While CMS shed 43 quality measures from federal reporting programs, only seven are electronic clinical quality measures collected via EHR system.
CMS removed the following eCQMs from the Hospital Inpatient Quality Reporting (IQR) Program as part of Meaningful Measures because the costs associated with each measure outweigh the benefit of its continued use:
- Primary PCI Received Within 90 Minutes of Hospital Arrival
- Home Management Plan of Care Document Given to Patient/Caregiver
- Median Time from ED Arrival to ED Departure for Admitted ED Patients
- Hearing Screening Prior to Hospital Discharge
- Elective Delivery
- Stroke Education
- Assessed for rehabilitation
In addition to removing the listed eCQMs, CMS also newly finalized two eCQM proposals in alignment with the aims of the Promoting Interoperability (PI) Program.
Starting in the 2019 reporting period, hospitals are required to submit one, self-selected calendar quarter of discharge data for four eCQMs in the Hospital IQR Program measure set. This policy is a continuation of the same reporting requirements adopted for the 2018 reporting period.
Hospitals will also be required to use 2015 edition Certified EHR technology (CEHRT) for eCQM reporting beginning in 2019.
CMS is also taking steps to reduce administrative burden by easing clinical documentation requirements and improving program flexibility.
Specifically, CMS removed a requirement mandating that certification statements detail where certain information can be found in EHRs. The federal agency also reduced the number of denied claims for clerical errors in documenting physician admission orders by removing requirements mandating that a written inpatient admission order must be present in the EHR as a specific condition of Medicare Part A Payment.
The federal agency will also provide flexibility for new urban teaching hospitals to enter Medicare Graduate Medical Education (GME) affiliation agreements. GME affiliation agreements allow hospitals to share full-time equivalent cap slots to accommodate resident cross training.
Additionally, CMS reduced clinical documentation requirements by allowing hospitals to use average hourly wage data from the IPPS final rule to demonstrate they are the only hospital in their labor market area in order to meet exemptions.
Finally, CMS revised regulations to allow certain hospitals excluded from IPPS to operate IPPS-excluded units.
“Overall, the rule will reduce the number of hours hospitals spend on paperwork by about 2 million hours,” stated CMS.