CMS Quality Improvement and Designing eCQM Program

CMS Quality Improvement and Designing an ECQM Program
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CMS Quality Improvement and Designing A ECQM Program
In 2016, the Center for Medicare & Medicaid Services (CMS) updated the Medicate Access and CHIP Reauthorization Act of 2015 (MACRA). The 2015 version of MACRA aimed to introduce new approaches in which physicians could be reimbursed, increase reliance on technology, and transition from the traditional fee-for-service to a new pay-for-performance method (Kauffman, Borden, & Choi, 2020). In contrast, the 2016 updates tie Medicare payments to cost and quality of care and accelerate the transition to value-based payment (VBP) by expanding pay-for-performance incentives. This change, also known as the Quality Payment Program (QPP), was expected to streamline, among other aspects of healthcare, the increase in the utilization of Electronic Medical Records (EHR). According to Hersey et al. (2019), the goal of QPP is to provide incentives emphasizing care quality and value instead of volume. Some of these incentives are based on the extent to which physicians achieve Meaningful use of EHR in clinical quality measure (CQM) reporting. In this view, the current paper analyses a case study. It discusses how a nurse leader can use a quality improvement process to analyze the issue presented in the case.
Case Overview
A group of family practice physicians is struggling to meet stage 2 requirements of meaningful use of EHR. A key observation is that the staff often forgets to provide patients with essential information like accessing the portal. The staff members have raised two complaints about the issue: insufficient time to explain the process to patients and that printed information is stacked in the utility room, hampering access. Analysis of this problem requires nurse leaders to adopt a quality improvement process. The quality improvement process acts as a lens through which this group of physicians can understand the problem, solve it, and take advantage of EHR incentives as prescribed under QPP.
Meaningful Use (MU) and EHR Incentive Programs
Meaningful use, according to Anumula and Sanelli (2012), is the utilization of resources in a manner that has a positive impact on patient care. In terms of EHR, meaningful use is an incentives program coordinated and run by the CMS. In other words, the CMS provides financial incentives to health organizations and physicians for the meaningful use of EHR technology. Aside from incentives, compliance with the guidelines of MU also results in reduced medical errors, automated refills, and improved access or availability of patient medical records. As they enter stage 2 of MU, the group of physicians must enhance their utilization of EHR or miss out on the benefits entailed in this stage. These benefits include avoidance of penalties, qualifying for incentives, coordination of care, increased safe access to information, enhanced patient engagement, and improved population health outcomes.
The key problems faced by the group of family practice physicians (GFPP) include staff having insufficient time to explain to patients how to access the portal and the stacking of printed information in the utility room. This means that the GFPP is falling short of clinical quality measure reporting. In other words, since patients are not accessing their EHR records and providing feedback as part of Electronic Clinical Quality Measures (eCQM), it means the GFPP is not reporting on key issues like patient and family engagement, the safety of patients, coordination of care, public health, the effectiveness of the clinical process, and efficient use of health resources. In order to improve on this aspect, the current problem of uninformed patients and the stacking of printed information in the utility room must be solved.
Contained within the eCOM library, as provided by CMS, are information about reporting options from which the GFPP can choose to improve patient engagement with EHR records. Two options apply to the EHR incentive program: attesting to CQMs through the EHR registration and attestation system and eReport CQMs through the Physician Quality Reporting System (PQRS) portal (CMS, 2023). These options not only help in sustaining meaningful use but also enhance patients' interaction with medical records. As outlined in stage 2 of Meaningful use, over 50% of all patients seen by an eligible physician (EP) within the EHR reporting period should have online access to their health records in under four business days once the information is available to the EP (Khullar, Bond, & O'Donnell, 2021). Further, the requirement calls for more than 5% of patients to be able to view, download, and transmit their health records to third parties within four days. These two requirements are currently not being met by the GFPP. To better analyze this problem, the GFPP must choose a quality improvement process to act as a lens through which current issues can be understood a...