Core Clinical Quality Measures for Eligible Physicians (EPs)

To demonstrate meaningful use of electronic health records (EHRs) under the Final Rule, EPs must report six clinical quality measures. Of these, three are “core” quality measures, which include:

• Hypertension: Blood Pressure Measurement
• Preventive Care and Screening Measure Pair:
  • a. Tobacco Use Assessment
  • b. Tobacco Cessation Intervention
• Adult Weight Screening and Follow-up

If the provider is unable to report on one of these clinical measures because the provider sees no patients addressed by the measures, three “alternate core requirements” are available for reporting:

• Weight Assessment and Counseling for Children and Adolescents
• Preventive Care and Screening: Influenza Immunization for Patients ≥ 50 Years Old
• Childhood Immunization Status

Menu Clinical Quality Measures for EPs

In addition to three core quality measures, to demonstrate meaningful use an EP must report on any three additional quality measures, as selected from a list of 38 possible measures.

Breast Cancer Screening Description: Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer

Smoking and Tobacco Use Cessation, Medical Assistance:

• Advising smokers and tobacco users to quit
• Discussing smoking and tobacco use cessation medications
• Discussing smoking and tobacco use cessation strategies description

Percentage of patients 18 years of age and older who were current smokers or tobacco users, who were seen by a practitioner during the measurement year and who received advice to quit smoking or tobacco use or whose practitioner recommended or discussed smoking or tobacco use cessation medications, methods or strategies Read more »

Department of Veteran Administration (VA) employees and contractors report a number of security breach incidents per month, so the world’s largest health care system is posting them on-line.

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The Centers for Medicare & Medicaid Services (CMS) issued a final rule that changes how physicians are paid for furnishing dialysis services for patients with end stage renal disease (ESRD) from partial bundled composite rates to a new partial payment system (PPS). The rule also establishes a quality incentive program (QIP) linking a facility’s payments to performance standards. This is the first time a QIP is part of a PPS.

Facilities failing to meet or exceed specified total performance scores will receive reduced reimbursement for dialysis services furnished on or after Jan. 1, 2012.

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The U.S. Department of Health and Human Services’ (HHS) updated July 7 HealthCare.gov’s Hospital Compare website with quality data on the rates of outpatient magnetic resonance imaging (MRI) for low back pain, outpatient re-tests after a screening mammogram, and two ratios that explain how frequently outpatient departments gave patients “double” computed tomography (CT) scans “when a single scan may be all that is needed.”

“This new update to CMS’ Hospital Compare feature will help patients and their families better compare quality at America ’s hospitals. And thanks to this new update this year,  for the first time, Medicare patients can see how efficiently facilities use certain types of imaging equipment and keep them safe from exposure to potentially harmful radiation that may not be necessary,” said HHS Secretary Kathleen Sebelius. Read more »

Updates to CPT® Category II codes posted July 2 on the American Medical Association (AMA) website include several new codes, revised short and medium code descriptors, and revisions to the Index of Alphabetic Clinical Topics. These updates, released July 1, will be implemented Oct. 1 and will appear in CPT® 2011.

Several new codes were added for reporting Parkinson’s disease. They are:

For diagostic/screening:

3700F Psychiatric disorders or disturbances assessed

3720F Cognitive impairment or dysfunction assessed

For therapeutic, preventative or other interventions:

4324F Patient (or caregiver) queried about Parkinson’s disease medication related motor complications

4325F Medical and surgical treatment options reviewed with patient (or caregiver)

4400F Rehabilitation therapy options discussed with patient (or caregiver)

For follow-up or other outcomes:

6080F Patient (or caregiver) queried about falls

6090F Patient (or caregiver) counseled about safety issues appropriate to patient’s stage of disease

The Centers for Medicare & Medicaid Services (CMS) released June 25 a preliminary version of the 2011 Medicare Physician Fee Schedule (MPFS) proposed rule. The proposed rule contains a number of policy changes that will affect practitioners who are paid under Medicare Part B. Many of the proposed changes are Affordable Care Act (health reform) provisions, which CMS is required to implement. Changes to the Physician Quality Reporting Initiative (PQRI) and the Electronic Prescribing (eRx) Program are among those provisions. Read more »

Nine hospitals in seven states recently agreed to pay the federal government more than $9.4 million to settle whistleblower allegations that they overcharged Medicare for spinal kyphoplasty procedures, the U.S. Department of Justice announced May 17. Experts say this isn’t the first settlement of this nature, and it won’t be the last.

In May and September 2009, the federal government reached settlements with nine other hospitals for alleged kyphoplasty-related Medicare fraud claims. In May 2008, Medtronic Spine agreed to pay $75 million to settle allegations that the company defrauded Medicare by counseling hospital providers to perform kyphoplasty procedures as an inpatient procedure when they should have been done on an outpatient basis.

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First year results for the Medicare Home Health Pay for Performance (HHP4P) demonstration are in and the news is good. The Centers for Medicare & Medicaid Services (CMS) announced May 6 that the demonstration saved the agency over $15 million. Incentive payments are being made to 166 home health agencies (HHAs) in the intervention group. Read more »

Memoranda from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary offer a mixed view of the impacts of the health care reform (HCR) bills passed this year. Noting that utilization will grow in CMS programs as various parts of the bills are enacted, Chief Actuary Richard S. Foster indicates reform will be more expensive than the Congressional Budget Office and Joint Committee on Taxation in his assessment titled, “Estimated Financial Effects of the ‘Patient Protection and Affordable Care Act,’ as Amended.”

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Minnesota’s Mayo Clinic is getting a mug shot of each patient with hopes that attaching it to the patient’s record will prevent errors. Mayo officials say the photos supplement other measures, such as asking names and birthdates multiple times before a procedure or service is performed. The technique also helps staff identify patients in the waiting room without calling their names—a boon to patient privacy.

Whether it’s a blood transfusion, a computed tomography (CT) scan, or a surgery, Dr. Chet Rihal told Rochester, Minn.’s Post-Bulletin, “We’ve got to make 100 percent certain we’ve got the right patient. We’ve got to go to extraordinary lengths to make sure that we are identifying the patient correctly.” Otherwise, the consequences can be dire, he said.

The patient’s photo pops up on the electronic medical record (EMR) when it’s brought up, triggering the physician’s memory, he explained. “I think it will be helpful when the patients call their doctors,” Rihal said.