As the HIT Policy Committee Meaningful Use Workgroup begins brainstorming what its stage 3 requirements might be in 2015, CIOs say one of the most valuable things the Centers for Medicare & Medicaid Services could do is harmonize all the programs to which providers must report quality measures.
As workgroup chair Paul Tang, M.D., explained, the Oct. 5 meeting of the workgroup is the beginning of a listening process that will use the experience with Stages 1 and 2 to inform what Stage 3 should look like and whether it will be possible to have more of a focus on measuring outcomes rather than processes.
Paul Tang, M.D.
Workgroup members heard from a panel of CIOs, chief medical information officers and regional extension center leaders. In both their spoken and written testimony, almost every speaker stressed the need for CMS to align its reporting programs to reduce the burden on providers.
For instance, Thomas Smith, CIO for NorthShore University HealthSystem in Evanston, Ill., estimated that his organization spent 36,000 employee hours on Stage 1, Year 1, and approximately 70 percent of that time was spent on getting reports correct, not improving quality. “Seventy percent of the effort shouldn’t be on reporting,” Smith said.
In his written testimony, Smith elaborated on the challenges his quality team faces. “We would like meaningful use quality measures to align with other initiatives, so that duplicate initiatives and reporting were not necessary. The difficulty comes about in managing the number of reporting requirements from The Joint Commission, states and federal agencies. There are at least three final rules within the last two years from CMS that specify the current requirements to meet for the annual payment update, which should be harmonized with the meaningful use stages.” Those rules involve inpatient quality reporting, value-based purchasing and readmission reduction. “The same group of indicators should meet the Joint Commission requirements and CMS,” Smith wrote. “We need to take the time back from massaging measurement and reporting and put this into the bedside for improving care and education of our patients and families.”
Other providers echoed Smith’s concern. In her written testimony, Carol Steltenkamp, M.D., CMIO for the University of Kentucky and director of the Kentucky Regional Extension Center, said that ideally, the quality measures of this program would align with the measurements of other initiatives. “Practitioners want to provide the highest quality of care but extracting the information necessary to document that provision remains a challenge,” she said. “To that end, most users have chosen to report on clinical quality measures that are part of their current workflow.”
Denni McColm, CIO of Citizens Memorial Healthcare, a rural healthcare network serving southwest Missouri, encouraged the use of clinical quality measures for meaningful use that are electronically specified versions of the quality measures that are used in other CMS programs. “For stages 2 and 3, we would like the clinical quality measures to be tested, validated and assigned to stewards before we are asked to use them,” she said.
It seems that CMS understands that it must move to align and simplify its reporting requirements. Patrick Conway, M.D., director of the CMS Office of Clinical Standards & Quality, told the workgroup meeting that his office is already working toward allowing clinical quality measure data submitted via certified EHRs to apply to all quality reporting programs. A longer-term vision, he added, could be hospitals and clinicians reporting through a single, aligned mechanism and receiving credit for multiple CMS programs. This would lessen provider burden while also supporting our goal of the programs transforming our system to provide higher quality care, better health outcomes, and lower cost through improvement.