Clinical quality measures required by meaningful use
To receive HITECH Act incentives, eligible providers must report on six of 44 clinical quality measures. This tip identifies those measures and explains how to send reports to HHS.
Eligible providers must do more than simply meet federal meaningful use criteria to receive Medicare and Medicaid...
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reimbursements under the Health Information Technology for Economic and Clinical Health (HITECH) Act. Providers must also report on six of 44 clinical quality measures. These "consist of measures of processes, experience and/or outcomes of patient care, observations, or treatment that relate to one or more quality aims for health care, such as effective, safe, efficient, patient-centered, equitable and timely care," according to the meaningful use final rule.
Preference has been given to the clinical quality measures endorsed by the National Quality Forum, for two reasons: First, the HITECH Act requires it; second, the NQF complies with National Technology Transfer and Advancement Act requirements.
For the 2011 calendar year -- the first year in which eligible providers are eligible for reimbursement -- organizations must use certified electronic health record (EHR) technology to collect data on the relevant hospital quality measures, then, as the meaningful use final rule puts it, "use an attestation methodology to submit summary information."
For 2012 and beyond, this information also must be submitted using a certified EHR system, provided that the Department of Health & Human Services (HHS) is able to receive electronic submissions by that time. If not, paper submissions will suffice. In the meaningful use final rule, HHS said that it will announce its readiness in the Federal Register.
This chart lists the 44 clinical quality measures required under Stage 1 of meaningful use. (The final rule's hospital quality measures are covered in a separate chart.) Eligible providers must report on three core quality measures and three additional measures over a period of 12 months. If the denominator of one or more of the core clinical quality measures is zero, a provider must submit as many as three alternative core measures.
For each measure, the NQF measure number, the Physician Quality Reporting Initiative (PQRI) implementation number, the measure's steward (or owner), and a description are provided. In all cases, the description refers to a percentage of patients. The breakdown of additional measures into such categories as cancer and diabetes is done purely for organizational purposes.
Additional information can be found on the electronic specifications page of the Centers for Medicare & Medicaid Services (CMS) website.
Core clinical quality measures (alternative core measures marked with *)
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128 | CMS/QIP 1 | Patients more than 18 years old whose BMI2 was calculated within six months, and who have a documented follow-up plan if BMI falls outside parameters |
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n/a | AMA- PCPI3 | Patients more than 18 years old who have a diagnosis of hypertension seen in at least two office visits, with blood pressure recorded |
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n/a | AMA-PCPI | Patients more than 18 years old who were seen at least twice and asked at least once about tobacco use in 24 months, and who received cessation intervention if they are users |
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n/a | NCQA4 | * Two-year-old children who received DTaP5, polio, MMR6, flu, hepatitis B, chicken pox, PCV7, hepatitis A and rotavirus vaccines by their second birthday |
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110 | AMA-PCPI | * Patients more than 50 years old who received a flu vaccine (September to February) |
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n/a | NCQA | * Patients from 2 to 17 years old who visited a primary care provider (PCP) or ob-gyn physician, had evidence of BMI percentile documentation, and received counseling for nutrition and physical activity |
Additional clinical quality measures: Diabetes
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1 | NCQA | Diabetic patients from 18 to 75 years old with high level of hemoglobin A1c |
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n/a | NCQA | Diabetic patients from 18 to 75 years old with low level of hemoglobin A1c |
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2 | NCQA | Diabetic patients from 18 to 75 years old with low LDL-C8 |
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3 | NCQA | Diabetic patients from 18 to 75 years old with low blood pressure |
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18 | AMA-PCPI | Patients more than 18 years old with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam, with documentation of the severity and presence or absence of macular edema, within 12 months |
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19 | AMA-PCPI | Patients more than 18 years old with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam, with documented communication to their PCP, within 12 months |
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117 | AMA-PCPI | Diabetic patients from 18 to 75 years old who received a retinal, dilated or negative retinal exam |
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119 | NCQA | Diabetic patients from 18 to 75 years old who received a nephropathy (urine) screening |
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163 | NCQA | Diabetic patients from 18 to 75 years old who received a foot exam |
Additional clinical quality measures: Heart conditions
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5 | AMA-PCPI | Patients more than 18 years old with a diagnosis of heart failure and LVSD9 who were prescribed an ACE10 inhibitor or ARB11 therapy |
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7 | AMA-PCPI | Patients more than 18 years old with a diagnosis of CAD12 and previous MI13 who were prescribed beta-blocker therapy |
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6 | AMA-PCPI | Patients more than 18 years old with a diagnosis of CAD who were prescribed oral antiplatelet therapy |
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8 | AMA-PCPI | Patients more than 18 years old with a diagnosis of heart failure and LVSD who were prescribed beta-blocker therapy |
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n/a | NCQA | Patients more than 18 years old discharged for acute MI, CAGB14, PTCA15 (from Jan. 1 to Nov. 1 of the year before reporting), or diagnosed with IVD16 in the reporting year and the previous year, who had a lipid profile done during the reporting year and who had a low cholesterol level |
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197 | AMA-PCPI | Patients more than 18 years old with a diagnosis of CAD who were prescribed lipid-lowering therapy |
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200 | AMA-PCPI | Patients more than 18 years old with a diagnosis of heart failure and paroxysmal/chronic atrial fibrillation who were prescribed warfarin therapy |
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201 | NCQA | Patients more than 18 years old discharged for acute MI, CAGB, PTCA (from Jan. 1 to Nov. 1 of the year before reporting), or diagnosed with IVD in the reporting year and the previous year, whose blood pressure is controlled |
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204 | NCQA | Patients more than 18 years old discharged for acute MI, CAGB, PTCA (from Jan. 1 to Nov. 1 of the year before reporting), or diagnosed with IVD in the reporting year and the previous year, with documented use of aspirin or other antithrombotic during the reporting year |
Additional clinical quality measures: Women's health
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n/a | AMA-PCPI | Women who gave birth during a 12-month period and who were screened for HIV during their first or second prenatal care visit |
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n/a | AMA-PCPI | Rh negative women who gave birth during a 12-month period and who received anti-D immune globulin at 26 to 30 weeks |
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n/a | NCQA | Women from 21 to 64 years old who received one or more Pap tests |
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n/a | NCQA | Sexually active women from 15 to 24 years old who were tested at least once for chlamydia during the reporting period |
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71 | AMA-PCPI | Female breast cancer patients more than 18 years old who were prescribed tamoxifen or an aromatase inhibitor within the reporting period |
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112 | NCQA | Women from 40 to 69 years old who received a mammogram |
Additional clinical quality measures: Cancer
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114 | NCQA | Patients from 50 to 75 years old who received a colorectal cancer screening |
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72 | AMA-PCPI | Colon cancer patients more than 18 years old who received, were referred for or were prescribed adjuvant chemotherapy within the reporting period |
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102 | AMA-PCPI | Prostate cancer patients at low risk of recurrence who received interstitial prostate brachytherapy, external beam radiotherapy, radical prostatectomy or cryotherapy |
Additional clinical quality measures: Asthma
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53 | AMA-PCPI | Asthmatic patients from 5 to 40 years old who were prescribed an inhaled corticosteroid or an acceptable alternative |
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64 | AMA-PCPI | Asthmatic patients from 5 to 40 years old who were seen at least twice and evaluated at least once for the frequency of daytime and nocturnal symptoms, within 12 months |
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n/a | NCQA | Asthmatic patients from 5 to 50 years old who were appropriately prescribed medication during the reporting period |
Additional clinical quality measures: Miscellaneous
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n/a | NCQA | Patients with a diagnosis of lower back pain who did not have an imaging study within 28 days of the diagnosis |
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9 | NCQA | Patients more than 18 years old who were diagnosed with a new episode of major depression and treated with antidepressant medication, and who remain on antidepressant medication treatment |
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12 | AMA-PCPI | Patients more than 18 years old with a diagnosis of POAG17 who have been seen at least twice and have had an optic nerve head evaluation within 12 months |
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111 | NCQA | Patients more than 65 years old who received a pneumococcal vaccine |
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n/a | NCQA | Patients from 18 to 85 years old with a diagnosis of hypertension whose blood pressure was controlled during the reporting year |
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66 | NCQA | Children from 2 to 18 years old diagnosed with pharyngitis and given an antibiotic and group A strep test |
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115 | NCQA | Smokers or tobacco users more than 18 years old who were advised to quit or use cessation medications or methods |
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n/a | NCQA | Adolescent or adult patients with alcohol or drug dependency who initiate treatment within 14 days of diagnosis and who have two or more service visits within 30 days of initiating treatment |
1 QIP: Quality Insights of Pennsylvania
2 BMI: body mass index
3 AMA-PCPI: American Medical Association's Physician Consortium for Performance Improvement
4 NCQA: National Committee for Quality Assurance
5 DTaP: Diphtheria, tetanus and acellular pertussis
6 MMR: Measles, mumps and rubella
7 PCV: Pneumococcal conjugate
8 LDL-C: Low-density lipoprotein cholesterol
9 LVSD: Left ventricular systolic dysfunction
10 ACE: Angiotensin-converting enzyme
11 ARB: Angiotensin receptor blocker
12 CAD: Coronary artery disease
13 MI: Myocardial infarction
14 CAGB: Coronary artery bypass graft
15 PTCA: Percutaneous transluminal coronary angioplasty
16 IVD: Ischemic vascular disease
17 POAG: Primary open angle glaucoma
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