Posted August 9, 2016 by admin in Latest News

Payment Rule to Change Clinical Quality Measure Requirements


The final rule for the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System (IPPS) brings significant changes to electronic clinical quality measures reporting for hospitals participating in the EHR Incentive Programs.


The final IPPS rule states that eligible hospitals and critical access hospitals will not have to report four quarters of data for eight of the 15 Hospital Inpatient Quality Reporting (IQR) clinical quality measures. In the proposed rule, hospitals and CAHs were required to report all 15 Hospital IQR clinical quality measures.

These changes apply to the 2019 payment determination and going forward.

According to CMS, they have made these changes to better align all agency programs and reduce the reporting burden for hospital employees. Several industry stakeholders have expressed frustration at the duplicative reporting requirements across various CMS programs, so in aligning the clinical quality measures collected in both the EHR Incentive Programs and in IPPS, the agency hopes to have alleviated some of those concerns.

“Our goal for the future is to align the clinical quality measure requirements of the Hospital IQR Program with various other Medicare and Medicaid programs, including those authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act, so that the reporting burden on providers will be reduced,” says the final rule, which has been published in digital format in the Federal Register.

“As appropriate, we will consider the adoption of clinical quality measures with electronic specifications so that the electronic collection of performance information is a seamless component of care delivery.”

As a result, CMS will need to establish more interoperable and robust technology infrastructure to better accommodate both EHRs and CMS data stores. Despite this difficulty, CMS says these modifications will ultimately lower program and hospital costs and improve the CQM reporting system on the whole.

“Once these activities are accomplished, adoption of measures that rely on data obtained directly from EHRs will enable us to expand the Hospital IQR Program measure set with less cost and reporting burden to hospitals,” the rule says.

“We believe that in the near future, collection and reporting of data elements through EHRs will greatly simplify and streamline reporting for various CMS quality reporting programs, and that hospitals will be able to switch primarily to EHR-based data reporting for many measures that are currently manually chart-abstracted and submitted to CMS for the Hospital IQR Program.”

Recently, CMS has faced much ado regarding the CQM reporting program. A recent surveyconducted by the American Hospital Association (AHA) and the Federation of American Hospitals (FAH) found that 78 percent of hospitals are not prepared to report their electronic CQMs (eCQMs).

According to the survey, 37 percent of hospitals have much work to do before the February 2017 reporting deadline, and 41 percent have at least some preparation. Only 18 percent report being in good shape leading into the deadline.

Hospital EHRs may be to blame for these difficulties. Among the handful of hospitals which reported that they will request an extraordinary circumstances waiver in place of reporting eCQMs, most said it was because of a newly-implemented or optimized EHR.

For all of these issues, however, the report showed some light at the end of the tunnel. Over half of the surveyed hospitals said that February 28, 2017 was a feasible deadline for eCQM reporting.

Hospitals cited employee skill and vendor support as primary reasons for their confidence. Sixty-four percent of hospitals said they were confident in their staff’s skills in data extraction for eCQM reporting, and most agreed that they had ample EHR vendor support in the endeavor.

Going forward, CMS will have to collect industry feedback and determine if the above-mentioned IPPS changes will help assist any apprehensive hospitals in eCQM reporting. Prior to the final rule’s release this past week, many hospitals reported that the IPPS clinical quality measure reporting requirements were too arduous. Ideally, the new modifications will help make the reporting simpler and more streamlined.


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