Clinical emergency data registry (CEDR) ACEP BOD Update April 2015

Evolution of Federal physician Quality Programs SGR Repeal and Medicare Provider Modernization Act of 2015: Merit-based Incentive Payment System (MIPS)

Evolution of Federal Quality Programs   2015 2016 2017 2018 Base 0.5% EHR Continues under current law PQRS VM

Evolution of Federal Quality Programs (continued) 2015-2018 2019 2020 2021 2022 2023 2024 2025 2026+ Base 0.5% 0.0% 0.25% EHR +/-4% MIPS +/-5% +/-7% +/-9% PQRS VM

MIPS Assessment Categories Quality initially includes measures from PQRS, EHR MU, & Qualified Clinical Data Registries (QCDRs) Resource Use initially includes measures from VM and episodes of care EHR Meaningful Use demonstrated by use of a certified system (not likely to apply to hospital-based physicians) Clinical Practice Improvement Activities gives credit for clinical practice improvement activities such as MOC Part IV and QCDRs.

How do QCDRs Fit Into MIPS? QCDRs will continue to be an important pathway to participation in the MIPS. The Secretary shall encourage the use of QCDRs. Measures used by QCDRs may also be used to assess performance. Use of QCDRs maintained by physician specialty organizations Professionals may also receive confidential feedback on performance through QCDRs. The Secretary is required to make Medicare claims data available to requesting QCDRs.

Total Impact of Participation in the Physician Quality Reporting System (PQRS) PQRS Programs: 2014 2015 Traditional PQRS Incentive +0.5% payment in 2015  PQRS MOC Incentive +0.5% payment in 2015 Total Potential PQRS Incentives +1.0% in 2015 PQRS Penalties For Failure to Report -2.0% in 2016 -2.0% in 2017 Value-based Modifier (VM)* For Failure to Report PQRS* -4.0% in 2017 Total Potential PQRS/VBPM Penalties -4.0% in 2016 -6.0% in 2017 Pay for reporting is being phased out Pay for performance & the Value-Based Modifier are being phased in The game is changing “Topped out” measures are being retired

PQRS Reporting Mechanisms Claims-based submission of Quality Data Codes (QDCs) EHR submission for MU Incentive GPRO Web Interface (primary care measures) Traditional Registry Reporting of PQRS Measures Qualified Clinical Data Registries (QCDRs)

Traditional PQRS registries Qualified Clinical Data Registries (QCDRs) Provide quality data for Medicare patients only Provides quality data on patients from all payers Limited to PQRS measures Includes PQRS measures plus up to 30 additional specialty specific measures Requires new “cross-cutting” measures Does not require “cross-cutting” measure Requires groups of 100 or more to report “PQRS-CAHPS” Does not require CAHPS reporting Less control over quality measures reported More meaningful measures to choose from Quality measure data collected will be used to calculate the quality composite of the Value Modifier. CMS will not include first-year QCDR measures in the VM quality composite until such time as CMS has historical data to calculate benchmarks for them. For the 2017 VM, in cases where groups are assessed under the “50% option” and all EPs report via QCDR in 2015, then CMS will classify the group’s quality composite score as ‘‘average’’.

What is CEDR? CEDR = Clinical Emergency Data Registry The first specialty-wide registry at a national level, designed to measure and report healthcare quality and outcomes. It will also provide data to identify practice patterns, trends and outcomes in emergency care.

CEDR Goals The scope of CEDR is to accept patient data from practicing emergency physicians and clinicians on the care provided to emergency department patients. These data will inform the main goals of CEDR, which are to: Provide a unified method for ACEP members to collect and submit Physician Quality Reporting System (PQRS) data, MOC, OCC, Ongoing Professional Practice Evaluation (OPPE), outcome data, and other related or applicable quality and patient safety data to meet quality improvement and regulatory requirements. Promote the highest quality of emergency care for our patients. Demonstrate the value of emergency care. Facilitate appropriate emergency care research. From RFP

2015 PQRS Measures Supported: Measure Title NQS Domain #54 12-Lead ECG Performed for Non-Traumatic Chest Pain Clinical Effectiveness #76 Prevention of Catheter-Related Bloodstream Infections (CRBSI): Central Venous Catheter Insertion Protocol Patient Safety #91 Acute Otitis Externa (AOE): Topical Therapy #93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use #187 Stroke and Stroke Rehabilitation: Thrombolytic Therapy (tPA); also known as hospital STK-4 #254 Ultrasound Determination of Pregnancy Location for Pregnant Patients with Abdominal Pain Slide 1 of 2 for PQRS measures to populate CEDR Collection mechanism: web-based data entry form; web-based data upload tool

2015 PQRS Measures Supported cont.: Measure Title NQS Domain #255 Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure Clinical Effectiveness #317 cross-cutting Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Community-Population Health #326 Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy (aka STK-3) Slide 2 of 2 for PQRS measures to populate CEDR

2015 CEDR Non-PQRS Measures Supported Measure Title NQS Domain #1 ED Utilization of CT for Minor Blunt Head Trauma for Patients Aged 18 Years and Older Efficiency & Cost Reduction #2 ED Utilization of CT for Minor Blunt Head Trauma for Patients Aged 2 Through 17 Years #3 Coagulation Studies in Patients Presenting with Chest Pain with No Coagulopathy or Bleeding #4 Appropriate ED Utilization of CT for Pulmonary Embolism #5 ED LOS for discharged ED patients – Overall Rate Patient Experience of Care #6 ED LOS for discharged ED patients – General Rate = (Overall Rate – Psych Pts– Transfer Pts) Slide 1 of 3 for non-PQRS measures to populate CEDR

2015 CEDR Non-PQRS Measures Supported cont. Measure Title NQS Domain #7 ED LOS for discharged ED patients – Psych Mental Health Patients Efficiency & Cost Reduction #8 ED LOS for discharged ED patients – Transfer Patients #9 Door to Diagnostic Evaluation by a Qualified Medical Personnel Patient Safety #10 Anti-coagulation for Acute Pulmonary Embolism Patients #11 Pregnancy Test for Female Abdominal Pain Patients #12 Three day return rate for ED visits Communication and Care Coordination #13 Three day return rate for UC visits Slide 2 of 3 for non-PQRS measures to populate CEDR

2015 CEDR Non-PQRS Measures Supported cont. Measure Title NQS Domain #14 Tobacco Screening and Cessation Intervention for Asthma and COPD patients Effective Clinical Care #15 tPA Considered Community-Population Health #16 Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis Efficiency & Cost Reduction #17 Adult Sinusitis: Appropriate Choice of Antibiotic #18 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis Slide 2 of 3 for non-PQRS measures to populate CEDR

CEDR Data Collection Data Pull Method: FIGMD fully manages the reporting process, with minimal impact to the practice. The vendor installs software on your local server, which queries the EMR's backend database and extracts relevant clinical data. This software runs passively in the background and does not affect clinical workflows or EMR performance. How long will it take for the first initial data extraction to be completed after mapping? Initially, it takes two to three weeks to collect the data. After data is collected, FIGMD reviews it with the practice and makes any necessary mapping adjustments.

CEDR Data Collection continued Data Push Method CEDR will provide participants with a template and data dictionary Participants will upload their own data from Revenue Cycle Management system (aka billing and coding/practice management systems) &/or electronic health record

Overview of Agreements Physician Group Agreement Business Associate & Data Use Agreement Authorized Vendor Agreement Hospital Agreement (Gov’t and Non-Gov’t) + Hospital BA/DU PQRS Participation & Submission Agreement

Achievements “Qualified” Status by CMS Acceptance/Approval of Quality Measures Acceptance/Approval of Data Validation Convened Clinical Data Registry Committee (CDRC) Informational Website: www.acep.org/cedr Enrollment of 370 “NPIs” or emergency clinicians from 3 test sites + email confirmations from several other groups who want to participate Northside Emergency Associates (Georgia) Maryland Emergency Physicians (MEP Health) Cascade Emergency Physicians (Washington State) Others: Beth Israel Deaconess Medical Center (Boston) University of Florida (Jacksonville) St. Anthony’s (St. Louis) – CEP America ED

Next Steps Finalize Data Dictionary Data into Dashboards Electronic Enrollment via the Website Promotion at EDPMA, LAC, R&C

CEDR Full Implementation Phase Questions? March -April 2015 CEDR Test Phase May -October 2015 CEDR Pilot Phase November-December 2015 CEDR Full Implementation Phase sjones@acep.org