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The Unintended Consequences of Electronic Clinical Quality Measures

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Many quality reporting programs are being to shift to the use of electronic clinical quality measures (e-measures). There are good reasons and benefit for accelerating this shift and reducing the labor and effort associated with previous manual approaches. However, there are some potential unintended consequences to this shift. Healthcare providers must pay even more attention to reviewing the integrity of their clinical data. Failure to do so could result in inaccurate reporting and create financial risk. By tightly combing quality reporting efforts with strong data governance practices, however, healthcare organizations will not just survive, but also benefit from, the move to electronic quality measure reporting.

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The Unintended Consequences of Electronic Clinical Quality Measures

  1. 1. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential © 2013 Health Catalyst www.healthcatalyst.com The Unintended Consequences of Electronic Clinical Quality Measures By Laura Dietzel, Director Regulatory Measures
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential E-Measures Acceptance Growing The move to electronic quality measure reporting As quality reporting programs begin shifting to the use of electronic clinical quality measures (e-measures), healthcare providers should prepare by reviewing the integrity of their clinical data. Failure to do so could result in inaccurate reporting and create financial risk.
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The Quality Reporting Burden Healthcare providers have been confronted with numerous requests from the Centers for Medicare and Medicaid Services (CMS), state agencies, specialty groups, and others to participate in various clinical quality reporting programs. With the introduction of the Electronic Health Record Incentive Program (Meaningful Use) in 2011 — and yet another quality reporting requirement — the volume of the calls for relief rose to a clamor.
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The Quality Reporting Burden This uproar is not surprising when you consider the apparent duplication between the list of quality measures required for Meaningful Use and other reporting programs. For example, hospitals participating in both the Core Measures Hospital Inpatient Quality Reporting Program (HIQRP) and the Meaningful Use program are required to report three entire measure sets — Stroke, VTE, and ED Throughput — to two different CMS agencies using two different sets of definitions and two different submission methods..
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Meaningful Use Introduces e-Measures for Quality Reporting When the Meaningful Use (MU) program introduced e-measures for quality reporting, it did so with no accuracy or performance requirements. Instead, eligible professionals and hospitals were asked only to demonstrate the ability to report e- measures. In general healthcare providers, faced with more immediate challenges, such as preparing for ICD-10 and MU stage 2, have not yet begun to review the accuracy of their e-measure reporting or address known issues.
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential What Causes Inaccurate e-Measures? There are two main reasons for e-measure inaccuracies: Missing data: E-measures are calculated using only the structured data collected in the certified EHR technology (CEHRT). Any e-measure data element not in the CEHRT can skew the accuracy of how the e-measure is calculated. To address the problem, healthcare providers may need to create or update several interfaces between the CEHRT and department or specialty modules. Alternatively, organizations using an enterprise data warehouse (EDW) may be able to leverage this tool to create the complete data sets needed to improve e-measure reporting accuracy. 1
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential What Causes Inaccurate e-Measures? There are two main reasons for e-measure inaccuracies: Data integrity: Quality e-measure inaccuracies may also be the result of data integrity issues, often caused by documentation or workflow variation. Take, for example, a scenario in which the hospital EHR is set up to automatically capture a patient’s arrival time as they are being registered with the emergency department. This may seem like an efficient way to collect patient information from the registration workflow but what if the patient is triaged first and then registered? In this case, a change in the workflow produces an inaccurate ED arrival time, which affects the accuracy of any e-measures using this data. 2
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential The IPPS Proposed Rule Raises the Stakes for E-Measure Accuracy In the recently published Inpatient Prospective Payment System (IPPS) proposed rule published in April, CMS is proposing that e-measures be the required reporting method for the HIQRP program as of calendar year 2016. If this proposal makes it to the final IPPS rule in August, hospitals will have a clear deadline by which e-measure accuracy issues must be found and resolved.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential E-Measures Moving Forward Using the e-measure model to report clinical quality measures will reduce the abstraction burden for physicians and hospitals, which is welcome news indeed! This would allow redeployment of valuable clinical resources from low-value data capture to high-value analysis and improvement activities. There are silver linings on the horizon
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential E-Measures Moving Forward With the move to e-measures, CMS and other agencies will be able to more quickly align and harmonize the quality reporting requirements of various programs and remove duplicative reporting burdens for hospitals and physicians. There are silver linings on the horizon
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential E-Measures Moving Forward Once data integrity issues are resolved, healthcare providers will be left with a far richer data set that can deliver value in a number of ways: robust clinical decision support rules, improved service line analytics, and improved readiness for future e-measure reporting requirements. There are silver linings on the horizon
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential E-Measures Moving Forward There are silver linings on the horizon There can be little doubt that the use of electronic clinical quality measures will accelerate as EHR technologies and standards continue to mature. A robust data governance program will help you prepare for – and take advantage of – this transition in quality reporting.
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential More about this issue: CMS Reporting Requirements: 4 Changes Hospitals Need to Know for 2014 Bobby Brown, Vice President Financial Engagement How Meaningful Use Can Lead to Meaningful Analytics Brian Ahier, Guest Blogger at Health Catalyst 4 Ways to Reduce Penalties Under the Hospital-Acquired Condition Reduction Program Bobby Brown, Vice President Financial Engagement Healthcare Reform: Implications For Your Health System (Webinar) Brian Ahier, Special Advisor Meaningful Use and ACO Reporting: Why You Need More Than Your EMR Leslie Hough Falk, RN, MBA, PM
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary and Confidential Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com Laura Dietzler joined Health Catalyst in February 2014 as the Director, Regulatory Knowledge. Laura has been working in the healthcare industry for over 25 years in roles that have included the payer, nursing home, ambulatory care, acute care and integrated delivery system settings. Just prior to coming to Health Catalyst, Laura spent 7.5 years at PeaceHealth, developing first the Core Measures/Transparency and then the HITECH/Meaningful Use programs.

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