4 Hurdles every hospital should jump through with electronic clinical quality measures

Meaningful Use penalties kick in soon and providers better be ready to submit quality measures properly to the Centers for Medicare and Medicaid Services (CMS). Until now most have just had to demonstrate the “ability to report” electronic clinical quality measures (eCQMs). Now providers need to ensure core measures will be generated and reported accurately to be eligible to receive their full annual payment. Since it’s very easy to lose visibility into whether or not accurate information is transmitted to CMS, providers should jump through some hurdles now or they’ll risk putting millions at stake.
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The right planning and technology helps hospitals hurdle challenges with eCQM reporting.

Here’s what keeps me up at night. Last year we experienced some big changes in quality regulations, and among these changes, the one that piqued the most interest was e- measures (eCQMs).  I can’t tell you how many questions I received from well-known quality reporting agencies who were recipients of the data, asking me how we were handling the changes because they understood the enormity and complexity of the new reporting guidelines. Combine that with an increasingly transparent healthcare industry with more information available online than ever before and it’s easy to see why quality reporting needs to be done well.

While most electronic health records (EHRs) support eCQMs, not all do, and there can be surprises. Additionally, few hospitals have done the testing and verification to ensure that when they press “send” starting March 2017, the data shared with CMS will be accurate and reflect the quality of care being delivered.

Here are 4 hurdles hospitals can overcome now to prepare for eCQM reporting.

  1. Identify the quality measures to report

For 2016 reporting , there are 28 clinical quality measures available for electronic reporting. Until recently hospitals used abstractors to identify and document these baseline care practices and submit them manually to CMS, so the data should be at hand. Identify which ones will be most impactful and successful for your hospital to report electronically first. Hospitals will be required to submit 4 of the 28 available eCQMs no later than March 13, 2017 using data collected in the 3rd or 4th quarter of 2016. This requirement changes again in 2017. Keep in mind, all submissions must be in a specific file format called the QRDA-1 file format.

  1. Know the financial impact

Hospitals’ annual payment update (similar to a base salary) is calculated based on their performance on core measures, which are standardized best practices designed to improve patient care. These can affect up to 1% of hospitals’ total Medicare reimbursement. For the average hospital with $140 million in Medicare revenue, this would put approximately $1.4 million at risk. When you’re operating on very thin margins (like all healthcare organizations), getting a pay cut in the millions can quickly put you into a financial crisis. Find the programs connected to these measures and ensure they excel in performance. Some tools offer core measures processing and performance updates through dashboards to track and improve key metrics.

  1. Ensure accurate data is prepped

EHR vendors are required to support eCQMs as a condition of Meaningful Use so many hospitals are leveraging their EHRs to handle the submission. However, not all EHRs or versions support ECQMs, and if yours falls into this category, you may need to prepare to file for a hardship with CMS for 2016.

While all eHR applications are required to be certified to submit electronic clinical quality measures using a standard format (QRDA I files), issues may arise, such as only one version being supported for eCQMs; vendors requiring a version update (for a cost); and/or referring hospitals to a third-party partner. In short EHR functionality is spotty at best. Also, unexpected things can happen with formatting of the files or data elements pulling from the wrong field in the EHR — all may lower a hospital’s payment rate. To prevent this, ensure  files are validated first; otherwise your hospital will have no way of knowing if the correct fields are actually being populated in the file. For health systems that support more than one EHR, the effort and guess work expand. When data files are generated from more than one system, each of these must be tested and verified for accuracy. There may also be challenges with aggregating results across a system.

  1. Choose a quality reporting tool that does the work for you

To mitigate the risks of quality reporting, use systems and processes that help monitor and improve performance by validating the QRDA 1 file prior to submitting to CMS; reporting where errors occur, and allowing corrections to the file before submission. You need a tool that can demonstrate how you provide care and prove it through core measures and patient data. Strive to find an eCQM tool that mirrors the look and feel and reporting functionality of your current “traditional” Quality Measures solution.  No one likes or can afford surprises!

To learn more about eCQMs join us for one of these upcoming webinars:

Webinar: eCQMs Success Strategies 

Join this webinar on February 16 from 11:00 am-12:00 pm to learn more about eCQMs, as well as hidden dangers and success strategies when it comes to quality reporting.

Register now

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Cathy Gorman-Klug

About Cathy Gorman-Klug

Cathy has over 30 years of experience in healthcare. She has extensive experience in project design, implementation, and management. In her current role as Product Manager, she is responsible for product strategy and product marketing for Nuance’s quality products. Previously, as a Corporate Director of Privacy and Data Security, she was responsible for compliance with requirements imposed by HIPAA, and other regulatory and accreditation standards for an integrated health system with over 7,000 employees. She holds a Master’s of Science in Nursing Administration from Seton Hall University.