Find the right solution to develop or expand your eCQM capabilities
Value-based healthcare that links provider reimbursements to their performances on quality-based benchmarks is now the new normal.
Consider the following:
- By 2018, CMS will tie 50% of all traditional Medicare payments to quality or value through new payment models.
- A 2015 survey found that 42% of hospitals received 10% or more of their revenue from value-based contracts.
- The nation’s second-largest health insurer, Anthem, recently announced its plans to ramp up value-based payments to providers of medical care beyond the nearly $40 billion annual commitment it is already making.
A critical but often overlooked aspect of this transition to value-based payment models is the movement to electronic reporting of Clinical Quality Measures (eCQMs). CMS, the Joint Commission, patient registries and other quality initiatives are now mandating that hospitals and providers submit many of their quality reports in eCQM formats.
Until recently, the EHR Incentive Program (Meaningful Use) has been the impetus for requirements in EHRs. Because of this, providers may turn to their EHR vendors to meet these requirements by default. Yet many hospital and healthcare system executives are unaware that EHR systems are not the only – and may not be the best — solution for reporting eCQMs.
Here are five questions to ask before deciding whether your current EHR system or a stand-alone solution would be the right choice to develop or expand your eCQM capabilities.
How does your EHR ensure that all eCQM information is accurate and complete?
The ability to consistently provide quality data for various reports is the most important function of any eCQM solution. This information not only is becoming the primary metric for value-based payments but also has a growing role in empowering evidence-based clinical and administrative decisions. Yet despite the fact that poor data quality can adversely affect hospitals’ finances, reputation and physician relationships, a recent American Medical Informatics Association (AMIA) statement noted that “healthcare providers generally lack faith in the accuracy and completeness of eCQMs.”
Studies have found that eCQM reporting compared to manual abstraction will typically show a significant under-reporting of performance. Experts also believe that, in the near future, CMS will require hospitals and physicians to verify the quality of their eCQM data.
Can your EHR solution access and capture all the required eCQM information?
E-measure calculations are done using only the structured data collected in certified EHR technology (CEHRT). However, data is often missing or incomplete because it is captured on paper but not electronically. Or even if captured electronically, it is not in a structured format.
And even when structured data is captured, it may only be available in a different setting of care or a standalone special software system. When a hospital’s internal systems (such as those in labs or emergency departments) have this necessary data but are not interoperable with EHRs, CEHRT data becomes inaccurate.
Most EHRs are not designed to capture unstructured or inter-departmental information at the level of detail needed for eCQMs. As a result, many hospitals expend considerable time and resources tracking down all the data sources and trying to validate this information. Ideally, an eCQM solution should be able to easily integrate clinical data, both structured and unstructured, in multiple formats.
How will your EHR eCQM solution affect care delivery and physician and staff productivity?
Hospitals often fail to consider the full repercussions of transitioning to eCQMs. For example, many mistakenly believe that eCQMs will eliminate or greatly reporting burdens. In fact, it’s more likely that their physicians and clinical staff will need to spend more time on eCQM data collection and verification issues. The use of eCQMs also might require a redesign of clinical workflows, which can also impact physician and staff productivity and caregiving processes.
Hospitals should look for a partner who understands the workflow, productivity and operational implications of eCQM data collection, review and submission. Since no “pure” eCQM solutions will be available for quite some time, providers could also benefit by outsourcing some eCQM abstraction and review responsibilities to quality information specialists who can provide an additional level of data accuracy validation.
Will your EHR eCQM solution provide transparency with concurrent review capabilities?
Transparency enables providers to identify data quality fallouts anywhere along the entire eCQM lifecycle, beginning with patient admissions. When providers or their data quality expert partners have immediate access to this information, documentation errors and omissions can be resolved before the eCQM is submitted.
For example, the mobile Q-Apps technology platform from Q-Centrix, which recently was certified as an EHR Module for generating, calculating and submitting eCQM data for hospitals and physicians, offers a way to check and confirm the accuracy of all 93 inpatient and ambulatory eCQMs. It also provides concurrent review capabilities for Core Measures, patient registries or any custom clinical protocols.
Will your EHR eCQM solution provide actionable information that can help improve quality management and patient care?
It’s not uncommon for hospitals (and EHR vendors) to see eCQMs as simply a technology issue concerning the ability to electronically transmit quality information to CMS. This view ignores two critical considerations. First, eCQMs will soon be essential for effective quality management, relating not only to CMS but also to various patient registries and other organizations and program.
Second and more importantly, eCQMs have the potential to become powerful tools for improving clinical practices and enhancing physician decisions at the point of care. Both hospitals and physicians should seek eCQM solutions that allow them to access and use real-time actionable data, a capability that is quickly becoming a core competency for the delivery of quality patient care.