In addition to meaningful use objectives, doctors and hospitals are required to report a number of quality measures that demonstrate more effective outcomes.
The quality measures reflect standards of care that providers are advised to follow. They also are influential across the health care spectrum, from determining the best treatment plans to deciding payments. Under the federal meaningful use requirements, physicians will have to report they are using certain standards in order to be eligible for financial incentives.
Under the final rule, eligible doctors will be required to report a set of three core quality measures, as well as three from another list. Hospitals must report a set of 15 measures. The Centers for Medicare & Medicaid Services (CMS) originally had proposed reporting on a greater number of measures, but the agency scaled back the criteria.
Because of the quality reporting already conducted for other state and federal initiatives, the CMS said in its final rule that it wanted to minimize the amount of reporting doctors and hospitals will have to do under its Electronic Health Record (EHR) Incentive Program. In addition, information for the selected measures can be collected electronically; that's not the case for all the quality measures that have been developed.
"We are limiting the clinical quality measures to those measures having existing electronic specifications as of the date of display of this final rule," the CMS wrote. "Additionally, as recommended by commenters, we will only require hospitals to submit that information that can be automatically calculated by their certified EHR technology."
The EHR Incentive Program, overseen by the CMS and the Office for the National Coordinator for Health Information Technology (ONC), defines what it means to be a meaningful user of health IT, and spells out in detail how providers who want to qualify for some $27 billion in incentive funds can become meaningful users.
As we go forward, quality measures will get better and better.
Janet Corrigan, president and CEO, National Quality Forum
Most of the quality measures in the incentive program have been endorsed by the National Quality Forum (NQF), a nonprofit organization that works with the public and private sectors to research and approve health standards. The measures have been vetted in a "rigorous" testing process and proved to yield useful results to health care stakeholders, said Janet Corrigan, the forum's president and CEO.
Originally designed to work with paper-based collection activities, the quality measures for Stage 1 of meaningful use have been retooled with the help of their original developers to allow information to be aggregated electronically. The NQF helped develop electronic specifications and language translations that EHR vendors can incorporate, Corrigan said. "It's important that standards do that in consistent ways."
For future stages of meaningful use, the NQF -- which has endorsed several hundred quality measures in the field -- expects standards to be developed electronically from the start. Electronic measures will offer more precise information and allow for better data analysis, Corrigan said. "With the EHR, it's more clinically rich. As we go forward, measures will get better and better."
CMS worked hard to "strike the right balance" of ensuring that providers use their EHR systems meaningfully while setting an achievable bar, Corrigan said. With the quality measures, there was a "high degree of coordination" between CMS and ONC. "It takes into account that measures are used for different purposes," she added.
Some of the quality measures providers will report on under the meaningful use rule already are components of other programs, such as the Physician Quality Reporting Initiative and the Reporting Hospital Quality Data for Annual Payment Update. The information collected from the latter program is used to populate the CMS' Hospital Compare website, which compares how well hospitals provide care in certain medical conditions and surgical procedures.
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