MU Stage1 Final Rule - Report Quality Measures (EP)

SECTION #  Section 170.302(i)—Report Quality Measures

MU OBJECTIVE Eligible Professionals: Report ambulatory clinical quality measures to CMS or the States.

MU STAGE 1 MEASURE For 2011, provide aggregate numerator, denominator, and exclusions through For 2011, provide aggregate numerator, denominator, and exclusions through attestation as discussed in section II(A)(3) of [the Medicare and Medicaid EHR Incentive Programs final rule]. For 2012, electronically submit the clinical quality measures as discussed in section II(A)(3) of [the Medicare and Medicaid EHR Incentive Programs final rule].

CERTIFICATION CRITERION Final Rule Text: §170.304(j). (1) Calculate. (i) Electronically calculate all of the core clinical measures specified by CMS for eligible professionals. (ii) Electronically calculate, at a minimum, three clinical quality measures specified by CMS for eligible professionals, in addition to those clinical quality measures specified in paragraph (1)(i). (2) Submission. Enable a user to electronically submit calculated clinical quality measures in accordance with the standard and implementation specifications specified in §170.205(f).

STANDARDS §170.205(f)

TEST CRITERIA # §170.304 (j) http://healthcare.nist.gov/docs/170.304.j_CalcSubmitClinQualityMeasures_v1.1.pdf

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Table 2A row 5 specifies that the criteria for PQRI be used. For submitting this for the ambulatory setting, and EHR may use the standard billing submission with addtional codes that are not yet part of VistA. In addition, there are 175 baseline quality measures from CMS that may be chosen for this reporting. Also of these would probably best be handled by some rich reminders, but creating reminders is a tricky process. As discussed elsewhere, Configuration of billing needs to be done in VistA and/or a billing system interfaced with or incorporated that has all of the necessary capabilities.

Matt King has agreed to work with the community collectively to create these reminders to feed into the output that needs to be submitted, but he feels that he has more to learn about doing creating reminders so there is a combination needed of those who want to learn a to then help create them and those who are experts and are willing to point out the problems in the creation of them. Unfortunately, the very fine VeHU training site that had a lot of reminder training that was very good has been partially deprecated deleting some of the best of the training. Nancy Anthracite has been informed that she ultimately will have her FOIA request for the site fulfilled, but so far that has not happened.

It may be that only one quality measure needs to be submitted to satisfy the CMS requirements for proof of Meaningful Use initially, but ultimately, groups need to submit 20+ measures, and which those measures are changes yearly and ambulatory clinics will need to submit about 6-8 in order to qualify. Laura Morales feels that some additional changes in demographics will be required for reporting.

Initial reporting of this will require use of 4010 X12 transactions with was avialable free of charge until 2006 so copies of that are available. 12/31/2011 the 5010 version will be required and these are very expensive. Nancy Anthracite has requested that the X12 membership for non-profit organizations be modified to include smaller nonprofits to lower the cost for access to the code and the staff of the standards body has submitted that request to the their leadership for consideration. There are discounts offered to members but the code sets still cost in the thousands of dollars and I suspect VistA from the VA, once it is configured, is using the 4010 sets. Nancy will try to find out when/if the VA will transition to the 5010 set. DEVELOPMENT STATUS (Add details here)

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