Clinical Quality Measures (CQMs) Jason Werner Michigan Department of Health and Human Services.

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Presentation transcript:

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 Eligible HospitalsTotals Unique # of participants5, ,017 Total Payments9, ,003 AIU Payments5, ,783 MU Payments4, ,220 Incentives distributed$153,121,995$157,002,686$310,124,681

CQM Reporting “As Is” 1)Direct Data Entry into eMIPP – Since )PDF upload into eMIPP – Since )QRDA Category III file upload into eMIPP – Since )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

State of Michigan Data Hub SOM Data Warehouse eMIPP CMS Repository PQRS VPN/REST API Convert to Desired Format 9 MIDIGATE ® “Catch, Detach, Dispatch” Trusted Data Sharing Organization Validate Store Quality Check Quality Score Validate Sender NPI and Use Case Agreement Senders Hospitals Providers Patients Quality Data Mart Clinical Quality Measure Reporting and Repository (CQMRR)

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?