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

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

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

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

5. 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.

6. 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.

7. 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

8. 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)

9. 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’’.

10. 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.

11. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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

21. Achievements “Qualified” Status by CMS
Acceptance/Approval of Quality Measures
Acceptance/Approval of Data Validation
Convened Clinical Data Registry Committee (CDRC)
Informational Website:
Enrollment of 370 “NPIs” or emergency clinicians from 3 test sites + 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

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

23. CEDR Full Implementation Phase
Questions?
March -April 2015
CEDR Test Phase
May -October 2015
CEDR Pilot Phase
November-December 2015
CEDR Full Implementation Phase