Quality Reporting May Prove Challenging Under Meaningful Use
I think it's fair to say that healthcare executives and physicians would all agree that the sooner hospitals, health systems, and physicians start gathering and reporting on quality indicators, the sooner healthcare quality can be improved. So it's not surprising that quality metrics are central to the meaningful use requirements outlined in the Centers for Medicare & Medicaid Services interim final rule.
What did surprise healthcare leaders, however, was the number of quality measures that is required for 2011. According to the rule, hospitals must report on 35 quality measures to meet the 2011 meaningful use requirements, including metrics on:
- Emergency department throughput, such as admission decision time to ED departure time for admitted patients and median time from ED arrival to time of departure from the ED for patients discharged from the ED.
- Ischemic stroke, such as the number of patients who arrive within two hours of symptom onset who receive thrombolytic therapy, and the number of ischemic stroke patients with atrial fibrillation who are prescribed anticoagulation therapy at hospital discharge.
- Venous thromboembolism prophylaxis, such as the number of patients who receive VTE prophylaxis within 24 hours of arrival or have documentation on why it wasn't given, and the number of patients with confirmed VTE who received anticoagulation overlap therapy.
- Acute-myocardial infarction patients, such as the number of patients who are prescribed aspirin or beta blockers at discharge.
- Hospital specific 30-day risk-standardized readmission rate following acute myocardial infarction admission, heart failure admission, and pneumonia admission.
- The ventilator bundle, such as elevation of head of the bed, daily "sedation interruption" and assessment of readiness to extubate, and peptic ulcer disease and deep vein thrombosis prophylaxis.
- The central line bundle, such as hand hygiene, chlorhexidine skin antisepsis, and optimal catherter site selection.
- Urinary catheter-associated urinary tract infection for intensive care unit patients, central line catheter-associated blood stream infection rate for ICU and high-risk nursery patients.
- Overall inpatient 30-day hospital readmission rate.
Even though the initial reporting will be done through attestation to CMS because the Department of Health and Human Services won't have the capacity to electronically accept data on clinical quality measures from electronic health records for the 2011 payment year, hospitals and physicians must still provide data on the quality measures as a condition of demonstrating meaningful use. HHS plans to have the capacity to receive electronic information on clinical quality measures from EHRs by 2012.
Currently, "we, as an industry, are only tracking—at least in Medicare pay-for-performance programs—about nine of those," says Steve Hanson, executive vice president of system alignment and performance for Texas Health Resources. And while all 35 are important, Hanson says, he hopes that CMS and the Office of National Coordinator will take the opportunity to focus on the "truly critical criteria" for 2011.
Tripling the number of quality measures that Texas Health Resource's reports on in less than a year is going to be difficult, acknowledges Ed Marx, senior vice president and chief information officer. One of the challenges is the maturity of the technology to produce the types of reports required in just a few key strokes, Marx says.