Transcription:

Alyne Ellis (Host): Lanette Hesse is a project specialist at MetaStar where she supports practices and providers participating in the Medicaid promoting interoperability program. Today she’s sharing with us information about clinical quality measures. This is MetaStar Health IT radio, the podcast from MetaStar. I'm Alyne Ellis. So Lanette, first off, what are clinical quality measures?

Lanette Hesse, MT(ASCP), HIT Pro–IM (Guest): E-clinical quality measures, or ECQMs, are really tools. Those tools help measure and track quality in healthcare in primarily six different areas. Those areas are broken down into number one is patient and family engagement. A second category would be patient safety. A third category is care coordination. Fourth can be population and public health. The fifth category is efficient use of healthcare resources. Finally we have a category for the efficacy of clinical process. I mainly work with providers, like you mentioned, that are participating in Medicaid’s promoting interoperability program. ECQMs is just one component of that program.

Host: So why are these tools important Lanette?

Lanette:  Well these tools are important because really metrics matters. These tools are a way to view specified outcomes or goals. Kind of think of it like a scoreboard or better yet even like a gauge or a compass. Most healthcare organizations use what we called EHRs or electronic health records. Therefore we refer to those CQMs are ECQMs. So to make it a little bit easier, let’s take an example of what a quality measure could look like. Let’s pick, for instance, focusing on controlling hypertension. These quality measures in their analysis, usually they're in a percentage format or score. So in this case for controlling hypertension, our numerator—or top number—would be the number of patients at a target blood pressure, like let’s say a normal blood pressure. The denominator would then be considered all patients with hypertension. Using the score or percentage we can have a target percentage that’s usually defined from evidence type based professional guidelines. We might call that benchmarking. We can use your output to benchmark within your organization, statewide, or even nationally.

Really another reason why these tools are important are different programs such as Medicare’s Quality Payment Program and then also Medicaid’s PI program use CQMs as one of the components. For instance, Medicaid’s PI has a requirement of reporting on at least six CQMs, and one of those really needs to be a high priority measure. This data really helps Medicaid and different programs in helping to align different administrative and clinical data to identify quality improvement focus areas.

Host: So what does high-priority ECQMs mean?

Lanette:  Well high-priority CQMs are really designated by different entities. For instance, in both Medicaid and Medicare they have deemed a few of the CQMs as high priority. They usually do this because those measures closely align with the respective initiatives and priorities. For instance, Medicare has deemed really 27 different high priority CQMs. Medicaid has identified about 25. 14 of those measures are the exact same between Medicare and Medicaid, but 11 of those measures are unique in Medicaid’s program. Those are usually determined based on local or state initiatives. We can see this year that there's a high priority around depression and/or treatment of depression. Things like controlling high blood pressure. There's also high priority CQMs around tracking immunization and cancer screening just to name a few.

Wisconsin’s Medicaid has published a really great document called Wisconsin’s Designated High Priority ECQMs and later on in the podcast I’ll talk about how to get ahold of them.

Host: So then let’s move on to some of the strategies that then lead us to ECQM success.

Lanette:  Well a few of the strategies we found out from being out in the field is really first you should identify your clinical quality measures on what's important to you or what aligns with your organizational goals. CMS has a really great reference for specification sheets regarding all the ECQMs. Also, it’s really important that you implement these CQMs using clinical workflows. Also, once you do the clinical work flows it’s really important that you utilize your vendors or your EHR vender’s workflows so that you can determine really what buttons or specific places the data needs to go into the EHR to be able to account for the correct data.

Also an important part and a good tip is to really know you're reporting period. This year the reporting period is 90 days if you're new to Medicaid’s promoting interoperability program. But if you've participated in the past then the reporting period is this entire year of 2019. The reason why that’s kind of important this year is 2019 is the first year for stage three. Therefore not every vender’s workflows were available the whole entire calendar year. One really good thing to note is that for this year, zero is an acceptable value in the CQMs denominator or numerator.

Host: So to me this would be a problem in a sense that if you don’t do this right, you’d have some barrier to achieving success. Maybe you can elaborate on what that might be. What trips people up?

Lanette:  Right. We’ve had a lot of experience out in the field. What we find most often are a few different things. One of them in subspecialties. So say you're a provider with a really specific specialty. You might have barrier to finding CQMs that are really relevant to your practice or specialty. We recommend then going ahead and picking the CQMs most closely matched to your subspecialty. Another barrier we see out in the field quite a few times is that if you're not able to get the vender specific workflow, it makes it really difficult to capture some of the data appropriately.

So say you're able to accumulate all the clinical processes but you might not be familiar with your vender’s workflow. That can cause issues when you go to put in the data that it might not be captured in the right place. For instance, let’s say you're working again with that high blood pressure and you need to record the follow up documentation. If you're not familiar with where your vender’s location is for that particular follow up, you might not get credit for that portion of the clinical quality measure. Lastly we just really want you to know that you're not navigating this journey alone. That we have created roadmaps from our experience in the field to help you.

Host: And where would we go to find that? Where would listeners go to get information and assistance on ECQMs?

Lanette:  Well the best place is metastar.com/podcast.

Host: Well we’re very grateful to have you explain this, the clinical quality measures to us today. So that’s Lanette Hesse, a project specialist at MetaStar. Thanks for checking out this episode of MetaStar Health IT Radio. For more information on this topic and to access the resources mentioned, please visit metastar.com/podcast. Be sure to check out all the entire podcast library for topics of interest to you. Thanks for listening.