The CMS EHR incentive program includes three foundational cornerstones:
1. Meaningful Use
2. Interoperability
3. Reporting Quality Measures
For the physician, reporting quality measures is accomplished by satisfying the Clinical Quality Measures (CQM) core objective. Physicians previously participating in the PQRI program will recognize many similarities between PQRI and the clinical quality measures. The CQM measures follow a similar format and in many cases are identical to existing PQRI measures. As with PQRI, the clinical quality measures consist of a denominator, which defines the population of patients eligible for the quality measure, and a numerator, which defines the quality action for each patient. Some ask simple questions (e.g., Was the diabetic patient’s HbA1c < 8 %?) and others are more complex (e.g., Did a patient with prostate cancer at low risk for recurrence and treated with 1 of 4 specific regimens have a bone scan at any time since the diagnosis of prostate cancer?).
One principal difference between PQRI and the EHR incentive CQM objective is the patient population under study. With PQRI this is frequently limited to a physician’s Medicare part B beneficiaries. As with the entire CMS EHR incentive program, the population the provider will report CQMs to CMS includes all comers—every eligible patient seen during the reporting period regardless of payer status.
The framework for reporting the CQMs is unique. There are a total of 44 CQMs available for reporting and each physician is expected to report 6 individual CQMs in order to meet this core meaningful use objective. Three of the measures must be “core” clinical quality measures and 3 must be measures from the CQM menu set. Within this framework the program does provide the physician with some flexibility when selecting CQMs to report.
There are a total of 6 core CQMs available; 3 are considered core and 3 are alternate core measures. The physician is expected to report all 3 core CQM measures. If 1 or more of these 3 measures is outside the physician’s scope of practice, they are expected to report a “zero” for that measure(s) and report an alternate core measure(s) in its place. If all 6 core measures are outside of the physician’s scope of practice they are expected to report “zeroes” for all 6. All certified EHRs will support reporting the 6 core CQMs and most will automate this process where possible for the physician. The 6 core measures are identified by title below:
Core
• Hypertension: Blood Pressure Measurement
• Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up
Alternate Core
• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older
• Childhood Immunization Status
For the nephrologist the only viable alternate core CQM is the one related to influenza immunizations. Depending on your scope of practice this CQM might take the place of the weight screening or perhaps the tobacco assessment CQM.
In addition to reporting a minimum of 3 core CQMs, the physician must report 3 CQMs from the menu set. The menu set contains 38 individual measures. Unfortunately the menu list does not contain nephrology specific measures. The nephrology specific PQRI measures for example did not make the final list for the CMS EHR program. The full list of core and menu set measures is available in a zip file on this web page. I have reviewed the 38 individual measures and have identified 10 that I think would be appropriate for the adult nephrologist to report on. (They are listed below with their corresponding National Quality Forum number.) Depending on the nephrologist’s scope of practice there are other measures on the menu list related to heart failure and ischemic heart disease that may be appropriate. Certified EHRs are only required to support 3 CQMs from the menu set so those of you shopping for an EHR (or currently using one), make sure your vendor supports menu set CQMs relevant to the practice of nephrology.
Nephrology “Friendly” CQMs
• NQF 0018 – Controlling High Blood Pressure
• NQF 0027 – Smoking and Tobacco Use Cessation
• NQF 0043 – Pneumonia Vaccination Status for Older Adults
• NQF 0055 – Diabetes: Eye Exam
• NQF 0056 – Diabetes: Foot Exam
• NQF 0059 – Diabetes: HbA1c Poor Control (>9%)
• NQF 0061 – Diabetes: Blood Pressure Control
• NQF 0062 – Diabetes: Urine Screen
• NQF 0064 – Diabetes: LDL Management and Control
• NQF 0575 – Diabetes: HbA1c Control (<8%)
I know it’s odd but yes there are 2 CQMs on the menu set related to HbA1c.
Reporting clinical quality data to CMS is one of the fundamental requirements of the EHR incentive program and as such there are no exclusions. It is possible to report “zeroes” for the 6 core CQMs and 3 CQMs from the menu; however, the provider in this circumstance must attest that all of the CQMs are outside his/her scope of practice. As with all other meaningful use objectives, 2011 reporting of the CQM objective will be through provider attestation. In 2012 and beyond; however, CMS anticipates receiving the clinical quality measures data electronically. Specific details related to this route of communicating CQMs to CMS will be forthcoming.
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