Clinical Quality Measures (CQMs)
Jason Werner
Michigan Department of Health and Human Services
Agenda
• Medicaid EHR Incentive Program Update
• “As-Is” environment for quality reporting for
Medicaid EHR Program
• “To-Be” environment for quality reporting for
Medicaid EHR Program
Medicaid EHR Incentive Program
Update
• Medicaid EHR Incentive Program is NOT
“dead” or going away
• eMIPP system currently accepting 2016
registrations as of 6/1/2016
• State of Michigan to roll out Stage 3 of
Meaningful Use beginning in program year
2017
• Dual eligible (MIPS/Medicaid EHR)
providers will have to attest separately
By the numbers
As of 4/30/2016
Eligible
Professionals
Unique # of participants
Total Payments
AIU Payments
MU Payments
Incentives distributed
Eligible
Hospitals
Totals
5,900
9,704
5,670
4,034
117
299
113
186
6,017
10,003
5,783
4,220
$153,121,995
$157,002,686
$310,124,681
CQM Reporting “As Is”
1) Direct Data Entry into eMIPP
– Since 2012
2) PDF upload into eMIPP
– Since 2012
3) QRDA Category III file upload into eMIPP
– Since 2013
4) QRDA Category III file upload via HIE/Direct
– Since June 1, 2016 (Optional)
Quality Reporting Document
Architecture (QRDA)
• Category I - A QRDA Category I report is an
individual patient quality report. Each report
contains quality data for one patient for one or more
eCQMs, where the data elements in the report are
defined by the particular measure(s) being reported.
• Category III - A QRDA Category III report is a
standard structure to use in reporting aggregate
quality measure data. Each report contains aggregate
quality data for one provider for one or more
eCQMs.
CQM Reporting “To Be”
• QRDA Category III file upload via HIE/Direct
– Beginning in 2017 (Required)
• QRDA Category I file upload via HIE/Direct
– TBD
Clinical Quality Measure Reporting and Repository
(CQMRR)
Quality Data Mart
Patients
Senders
eMIPP
Trusted Data Sharing
Organization
SOM Data
Warehouse
Convert to
Desired Format
Providers
VPN/REST API
Quality Score
Q
R
D
A
Hospitals
State of Michigan
Data Hub
Quality Check
VPN/REST API
MIDIGATE®
[email protected]
“Catch, Detach, Dispatch”
Q
R
D
A
Q
R
D
A
Store
Q
R
D
A
Validate
PQRS
Validate Sender
NPI and Use Case
Agreement
CMS
Repository
Future For Providers
• CQMRR will be able to give feedback on
statewide, regional, county level averages.
• CQMRR will be able to compare providers
within a practice.
• CQMRR will be able to compare
clinics/hospitals based on measures.
Future For Consumers
• Make CQM data available in a public facing
website for consumers to be able to conduct
their own research.
– Offer filters on specialty, county, measure etc.
Barriers to Success
• EHR vendor participation and cooperation
• Variance in QRDA structure
– NPI not always required
• MU does not require a standard CQM set
based on specialty
– Does not allow for apples to apples comparison
• Can a standard measure set be agreed upon
for all CQM submission (Report Once)?
• Need to be able to identify location
Why this can be successful
•
•
•
•
Built on standards (QRDA)
Expertise (MiHIN, CNSI, Optum etc.)
One front door (CQMRR)
Sustainable (Built on 90/10 funding, cost
sharing among states and initiatives in
future)
• Demonstrated Value (Report Once, clean
data in end points)
Questions?
www.MichiganHealthIT.org
[email protected]