RevAspire - Clinical Quality Measures 2018 Brett M. Paepke, OD Director – ECP Services Marni Anderson Manager – Quality Reporting Initiatives Libby MacFarland Quality Reporting Specialist
Why discuss clinical quality measures? • The CQMs are likely what you’ll use to participate in the Quality category of MIPS in 2018 • Clinical quality measures (CQMs) are automatically tracked for you by RevolutionEHR • Important to understand how you’re scored so that you can excel
Paths to Quality Category Participation Claims-based EHR Direct (CQMs) Satisfied Requirement QCDR (AOA MORE) Qualified Registry Different methods of participation can have different measures
Anatomy of a Clinical Quality Measure • Denominator: the patients included in the measure • Numerator: the patients who have a certain quality action taken • Exclusion: patients who are removed from consideration based on a status or pre-existing condition • Exception: patients who are removed from consideration based on a provider-documented reason • Can be patient-based and/or medical-based depending on CQM • i.e. a patient refusing dilated examination can be removed from consideration in the diabetic retinopathy measures
Clinical Quality Measure Facts • RevolutionEHR does not define how the CQMs are calculated • CQMs can change slightly each year • Higher score doesn’t always indicate better care • i.e. Use of High-Risk Medications in the Elderly
Non-Surgical CQMs in RevolutionEHR • Diabetes: Eye Exam • Closing the Referral Loop • Documentation of Current Medications in the Medical Record • Use of High-Risk Medications in the Elderly • POAG: Optic Nerve Evaluation • Diabetic Retinopathy: Macular Edema and Severity • Diabetic Retinopathy: PCP Communication
Relationship to MIPS - Quality • You will be evaluated on your 6 best- • Diabetes: Eye Exam scoring measures • Closing the Referral Loop • Documentation of Current • 4 measures offer the opportunity for Medications in the Medical Record high-priority bonus points • Use of High-Risk Medications in • You will receive 1 bonus point for each the Elderly • POAG: Optic Nerve Evaluation measure submitted by RevAspire J • Diabetic Retinopathy: Macular Edema and Severity • Diabetic Retinopathy: PCP Communication
Relationship to MIPS - Quality
Diabetes: Eye Exam (CMS 131v6) • Denominator: patients age 18-75 with an active diagnosis of diabetes and an encounter during the measurement period • “Encounter” includes 92xxx and 99xxx series codes • Numerator: patients in the denominator who had a retinal exam during 2018 or no evidence of retinopathy in 2017 • Exclusions: patients who were in Hospice care during the measurement period • Exceptions: none
No Evidence of Retinopathy in Retinal Exam Year Prior to Measurement Period Diab Ret Grd = “None” OU ≥1 entry on Fundus test DME Y/N = “N” OU
Closing the Referral Loop (CMS 50v6) • Denominator: Number of patients who were both referred by one provider to another during and who had a visit during the measurement period • “Visit” includes 92xxx and 99xxx series codes • Numerator: Number of patients in denominator for whom the referring provider received a report from the provider to whom the patient was referred • Exclusions: none • Exceptions: none
Checking ”Report Received” is the numerator scoring action
Documentation of Current Medications in the Medical Record (CMS 68v7) • Denominator: patients age ≥18 years old with and an office visit during the measurement period • “Office Visit” includes 92xxx and 99xxx series codes • Numerator: number of patients in denominator for whom the EC attests to documenting, updating or reviewing the patient’s current medications using all immediate resources • Exclusion: none • Exceptions: medical reasons where patient is in an urgent situation where delay of treatment would jeopardize the patient’s health
Selecting ”Reviewed” is the numerator scoring action
Use of High-Risk Medications in the Elderly (CMS 156v6) • Denominator: Patients ≥65 who had a visit during the measurement period • “Visit” includes 92xxx and 99xxx series codes • Numerator 1: Patients with an order for at least one “high-risk medication” during the measurement period OR an order for at least one “high-risk medication with days supply criteria” with a cumulative medication duration > 90 days during the measurement period. • Numerator 2: Patients with two orders for the same “high-risk medication” during the measurement period OR two orders for the same “high-risk medication with days supply criteria” with a cumulative medication duration > 90 days during the measurement period. • Exclusion: patients who were in Hospice care during measurement period • Exception: none
Use of High-Risk Medications in the Elderly (CMS 156v6) • Tracks medications you prescribe • Inverse Measure • A low numerator/score is good here! • ODs don’t prescribe medications on the lists considered “high risk” • High-priority and CEHRT bonus points for reporting this measure successfully • YOU WILL DO VERY WELL ON THIS MEASURE WITHOUT PAYING ANY ATTENTION TO IT J
POAG: Optic Nerve Evaluation (CMS 143v6) • Denominator: patients ≥18 years old with an active diagnosis of primary open-angle glaucoma and one or more office visits during the measurement period • “Office Visit” includes 92xxx and 99xxx series codes • Numerator: Patients who have an optic nerve head evaluation during one or more office visits within the measurement period • Exclusion: none • Exception: a medical reason is provided for not performing an optic nerve head evaluation • i.e. “Not Indicated” during a dry eye visit • see appendix of 2018 eCQM Scoring Guide for complete list
POAG: Optic Nerve Evaluation (CMS 143v6) Optic Nerve Evaluation = documentation of all the following for at least 1 eye: • Vert C/D • NR Rim • Color • Margins
Diabetic Retinopathy: Macular Edema and Severity (CMS 167v6) • Denominator: patients ≥18 years old with an active diagnosis of diabetic retinopathy and an office visit during measurement period. • “Office Visit” includes 92xxx and 99xxx series codes • Numerator: Patients who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy AND the presence or absence of macular edema during one or more office visits within the measurement period. • Exclusion: none • Exception: a medical or patient reason is provided for not performing a dilated macular or fundus examination. • Medical example: “Not indicated” • Patient example: “Patient refused” • see appendix of 2018 eCQM Scoring Guide for complete list of exceptions
Diabetic Retinopathy: Macular Edema and Severity (CMS 167v6) • Level of severity of retinopathy = “Diab Ret Grd” other than “None” for at least one eye • Presence or absence of macular edema = “DME Y/N” for at least one eye
Diabetic Retinopathy: Communication (CMS 142v6) • Denominator: patients ≥18 years old with an active diagnosis of diabetic retinopathy and a dilated macular or fundus examination during the measurement period. • Numerator: Patients with documentation of the findings of the dilated macular or fundus examination communicated to the physician who manages that patient’s diabetes • Exclusion: none • Exception: a medical or patient reason is provided for not performing a dilated macular or fundus examination. • Medical example: “Not indicated” • Patient example: “Patient refused” • see appendix of 2018 eCQM Scoring Guide for complete list of exceptions
Diabetic Retinopathy: Communication (CMS 142v6) “Dilated macular or fundus examination” = • “Diab Ret Grd” other than “None” for at least one eye • “DME Y/N” for at least one eye
Diabetic Retinopathy: Communication (CMS 142v6) “Communicated to the physician who manages that patient’s diabetes”= 1. Print/save 1 of 4 encounter summaries Diabetes Encounter Summary for PCP • Vision Source Diabetes Encounter • Summary for PCP Vision Source Diabetes and Glaucoma • Summary for PCP Any HTML template marked for • inclusion in the measure
Diabetic Retinopathy: Communication (CMS 142v6) “Communicated to the physician who manages that patient’s diabetes”= 2. Letter addressed to “Provider” or “External Provider”
Diabetic Retinopathy: Communication (CMS 142v6) • Common topics of discussion • Patient must have active retinopathy in diagnosis history • Patient must have “Diab Ret Grd” and “DME Y/N” completed for at least 1 eye • Name of letter template cannot be edited if using Flex version • OK to edit body of letter, but not name • Letter must be generated within encounter where dilated macular or fundus examination was performed Numerator of Macular Edema measure = Denominator of this measure
Scoring Demonstration • RevolutionEHR • Related resources (located on same page as this webinar) • 2018 Clinical Quality Measure scoring guide • 2018 MIPS Quality measure benchmark document
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