Quality Measures Workgroup

Quality Measures Workgroup

September 25, 2013

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Charge

Overarching Charge to QM WG and ACQM Subgroup:• Develop recommendations for how electronic clinical quality measure

concepts and specific measures could be used in place of MU objective measures to “deem” eligible providers (EPs) and eligible hospitals (EHs) as meaningful users through their ability to perform on quality outcomes.

Specific Charge to QM WG:• HIT-sensitive outcome measures for EPs are ideal for deeming.

– What are the criteria and the potential framework for deeming?– Which measures that currently exist in CMS programs are appropriate to use for

deeming? • Eligible professionals and group reporting

– What parameters should be used for a group reporting option for MU overall (including deeming).

– If there is a group reporting option, how do you attribute a provider's membership in a group and his/her ability to receive incentives (or avoid penalties)?

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Previous Discussion on Deeming

• Deeming: – HIT-sensitive, outcome-oriented – Population focused (i.e., Million Hearts, disparities, frail

elderly)• Framework would support:– High or improved performance – Reduction in disparities– Encompass the aspects of the MU Stage 2 objectives

but does not need to map one-to-one– Patient-reported outcome measures

04/22/2023 Office of the National Coordinator for Health Information Technology

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ACQM Subgroup Discussion

• Focused on recommending measures that were global indicators of health– e.g., patient-reported outcome of how well the system

coordinated care for the frail elderly• Healthcare outcomes or intermediate outcomes would be

used to ensure improvement on the global indicator but not required for reporting– e.g., readmissions rates, total cost of care, number of days living

in the community• Also wanted to be sure that this framework would address

the burden to the system to implement and report this information

04/22/2023 Office of the National Coordinator for Health Information Technology

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Goals for this Call

• Discuss draft criteria and examples for “deeming” of eligible providers

• Develop final draft recommendations on the criteria and exemplars for HIT Policy Committee meeting on October 2

* Table 1 from A Framework For Accountable Care Measures. Posted in Health Affairs blog by Richard Bankowitz, Christine Bechtel, Janet Corrigan, Susan D. DeVore, Elliott Fisher, and Gene Nelson on May 9, 2013.

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Draft Criteria

1. State of readiness: measure is in widespread use or ready for use in Stage 3

2. Preference for alignment with other measurement programs (e.g., PCMH, readmissions, CAHPS)

3. Preference for eCQMs4. HIT-sensitive: evidence that the relevant HIT

functions (e.g., clinical decision support) linked or associated with the eCQM result in improved outcomes and/or clinical performance

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Draft Criteria

5. Preventable burden: evidence that measurement could support potential improvements in population health and reduce burden of illness

6. Supports health risk status assessment/outcomes AND improvement: supports assessment of patient health risks that can be used for risk adjusting other measures and assessing change in outcomes AND demonstrates improvement

7. Enables patient-focused longitudinal care: enables assessment of a longitudinal patient-focused episode of care

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Draft Criteria

8. Cross-cutting in focus: preference for measures that are applicable across settings and conditions

9. Feasible for implementation: benefit of measuring outweighs the burden of data collection and implementation

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Million Hearts Exemplar

Measure State of Readiness

Alignment

eCQM HIT-sensitive

Preventable Burden

Health Risk/Outcom

es & Improvement

Enables Longitudinal

Care

Cross-cutting

in Focus

Feasible

Screening High High High High High High Medium Low High

LDL Control

High High High High High High High Low High

BP Control

High High High High High High High Low High

Smoking Status

High High High Medium High High Medium Low High

HbA1c Control

High High High High High High High Low High

AMI Total Cost of Care

High Medium Low Medium Low Medium High Low High

AMI Mortality

High Medium Low Low High High Low Low High

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Frail Elderly Exemplar

Measure State of Readiness

Alignment

eCQM HIT-sensitive

Preventable Burden

Health Risk/Outcom

es & Improvement

Enables Longitudinal

Care

Cross-cutting

in Focus

Feasible

Screening for Future Fall Risk

High High High High High Medium High Low High

Use of High-risk Meds in the Elderly

High High High High High High High Low High

CG-CAHPS

High High Low High Low Medium High High Medium

Closing the referral loop

High High High High Low Medium High Low High

Re-admissions

High High Low High High High High High High

Total Cost of Care

High Medium Low Medium Medium Medium High High High

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Questions for Discussion

– Are the draft criteria correct? What addition or changes should be made?

– Recognizing that there are tensions between some of the draft criteria, which, if any, should be prioritized?

– Are the exemplars included appropriate and aligned with the criteria?

–What additional measure concepts should be recommended for future development to enable “deeming” of EPs?