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CMS wants to boost CQM reporting in EHR certification

CMS is giving health IT organizations until Feb. 1 to comment on requiring EHR vendors to annually recertify CQM reporting modules and increase the number of CQM measures.

CMS ended 2015 with a little-noticed request for comment on a proposal to require EHR vendors for the first time to annually recertify clinical quality measures reporting modules, and to boost the number of CQMs to as many as 25.

Interested parties have until Feb. 1 to comment on a series of options to improve CQM reporting. CMS outlined its recommendations in a request for information (RFI) the agency issued Dec. 30.

Clinical quality measures, required under meaningful use, are standards for assessing observations, treatment, processes, patient experience and outcomes of medical care, according to the Office for the National Coordinator for Health IT (ONC), which certifies EHRs for meaningful use incentive eligibility.

"The RFI provides CMS and ONC with an opportunity to assess policy options that could improve the effectiveness of the certification of health IT, and, specifically, the certification and testing of EHR products used for the reporting of quality measures," Kate Goodrich, M.D., director of the CMS Center for Clinical Standards and Quality, wrote in a blog post accompanying the RFI. "We aim to streamline/reduce provider, hospital and health IT developer burden."

CMS officials will use feedback from the RFI in forthcoming proposed rulemaking for CQM reporting and certification.

CQM measures part of value-based reimbursement

The RFI language ties changes in CQM reporting and EHR recertification by ONC to the stage 3 meaningful use rule and criteria that physicians, hospital systems and critical access hospitals must meet to receive incentive payments and to avoid lower Medicare reimbursement payments.

Up to now, meaningful use has generally required that providers -- depending on specialty and whether they work in inpatient or outpatient settings -- track and report on nine quality measures in areas such as pediatric care, patient safety, cardiac surgery and readmission rates for cardiac patients.

That list could increase to 15 for physician practices and 25 for hospitals, according to the RFI.

AMIA is 'guardedly optimistic'

Jeff Smith, vice president for public policy for the American Medical Informatics Association (AMIA), told SearchHealthIT that CMS' CQM reporting initiative is clearly part of the overarching strategy of its parent agency, the Department of Health and Human Services, to move federal healthcare reimbursement to value-based payments.

That approach is embodied in MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which established a framework for moving from fee-for-service to value reimbursement, Smith noted.

We've got to get to the point where everyone is comfortable with how quality measures are reported.
Jeff Smithvice president for public policy, AMIA

CQM reporting measures are important in determining value and outcomes. But CQM measures have until now been in disarray because of the lack of agreement among providers, regulators and vendors over care quality measure standards. In turn, that makes it difficult for vendors to incorporate standardized CQM reporting technologies into their EHR systems, Smith said.

Smith said his initial reaction to the RFI -- which he said he expects to be among the first of a salvo of CMS moves in other health IT areas to come this year -- was "guardedly optimistic."

"These are the kind of questions the federal government should have been asking for over the last couple of years," Smith said. "We've got to get to the point where everyone is comfortable with how quality measures are reported."

CHIME says EHR certification focus narrow

While AMIA's view of the CMS move on CQM reporting was somewhat positive, Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives, or CHIME, said healthcare CIOs have reservations.

"We are pleased CMS and ONC have recognized the need to evaluate the capabilities of certified electronic health records to generate electronic clinical quality measures," Krigstein said in an emailed statement. "However, the conversation on electronic clinical quality measurement shouldn't focus solely on the performance and expectations of certified EHRs."

CIOs think quality measurement problems, such as duplicative reporting and capturing outcomes, and the need for better quality measurement guidelines for population health are still being addressed in Congress, Krigstein said.

In the meantime, Krigstein and Smith said their groups are working on submitting commentary by the start of February.

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