Tuesday, September 28, 2010

Clarifying the Meaningful Use Quality Measures

As the country prepares for meaningful use stage 1, many are studying the functionality of their EHRs, hospital information systems, and data warehouses to ensure they can produce the ambulatory and hospital quality measures.

This has led to many implementation questions.

The ambulatory measures and guidance are detailed on a previous blog.

The hospital quality measures for 2011-2012 are found in pages 303-305 of the Final Rule, available here.

Additional guidance from CMS is available here.

The detailed HITSP documentation detailing the standards for computing numerators and denominators is available here.

The most useful, focused, and streamlined materials are the definitions of the quality measures. These measures are encoded according to the HL7 Health Quality Measures Format. To view them

1. Download the HITSP_Quality_Measures_20100430.zip file.
2. Create a new folder on your hard drive.
3. Extract the entire contents of the HITSP_Quality_Measures_20100430.zip file into the new folder.
4. Open the new folder.
5. Double click on a file to open and read the individual .xml files using your internet browser

For the two Emergency Department (ED) Throughput measures, ED-1/NQF 0495 and ED-2/NQF 0497, the information on the numerators/denominators/exclusions is available here.  To fall into the admitted to the emergency department denominator a patient must do two things:

1)      Initially present at the ED

Then either 2) be subsequently admitted to the inpatient side or 2) receive observation services.

A patient seen in the ED who is neither admitted or receives observation services would not be in the denominator.

Hospitals have varying rules about where they provide what type of observation services and patients could receive observation services without ever going through the ED just like they could be admitted to the hospital without ever going through the ED. It is not CMS' intent to expand into Place of Service (POS) Code 22 (Outpatient Hospital - A portion of a hospital which provides diagnostic, therapeutic (both surgical and non-surgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.). This is why CMS had to include the first criteria.

I hope these resources are helpful to you.


Paul Roemer said...

Thanks John. It would be interesting to poll what percentage of hospitals are trying to meet stage 1, and then to find out which percentage met it. I think both numbers will be low, and I will be surprised if the percentage who actually receive the incentive money exceeds 10%.

Anonymous said...

I would be interested in getting your or other reader's feedback on the quality measures implementation as described in the specifications. The specifications include codesets that are not widely in use (i.e. SNOMED, ICD-10) or specify inpatient data in the ambulatory measure specifications, which few ambulatory EMR's would have access to. Should people be implementing these measures to the letter of the specification, or try and capture the spirit within the limits of the technical capabilities of their system?

Unknown said...

As always, your posts include well-researched and up-to-the-minute information. Very helpful, thank you.

Unknown said...

Is there any information available for a provider who does not agree with a certain measure and would like to submit his/her thoughts on exclusion/inclusion criteria?