Clinical Quality Measures (CQM)
CMS (Centers for Medicare and Medicaid Services) has created clinical quality measures (or CQMs) that are used to measure and track the quality of healthcare services you receive as a patient. According to CMS.gov CQMs “measure many aspects of patient care including: health outcomes, clinical processes, patient safety, efficient use of healthcare resources, care coordination, patient engagements, population and public health, and clinical guidelines. Continuously measuring and reporting these CQMs helps to ensure that our health care system can deliver effective, safe, efficient, patient-centered, equitable, and timely care.”
These measures were created and became a requirement of Meaningful Use (MU) and for more information on the specifics of MU see the MU section of this book. With regards to ARRA (American Recovery and Reinvestment Act), everyone is required to report on core clinical quality measures and clinical quality measures selected from a list. If you don't collect the information on one or more of the core measures (or it reports zero), you replace them with other items from the list. These are not calculations but reports that are created from your EMR and the data reported as it appears on the report. There is not a minimum value to achieve - it just needs to be reported (for the requirements as of today).
Core Quality Measures required for MU:
NQF0013 Hypertension: Blood Pressure Measurement
NQF0028 Preventative Care and Screening Measurement Pair:
1) Tobacco use assessment
2) Tobacco Cessation Intervention
NQF0421/PQRI128 Adult Weight Screening and Follow-up
Additional List of Clinical Quality Measures:
1) Diabetes: Hemoglobin A1c Poor Control
2) Diabetes: Low Density Lipoprotein (LDL) Management and Control
3) Diabetes: Blood Pressure Management
4) Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)
5) Coronary Artery Disease (CAD): Beta-Blocker Therapy for CAD patients with prior Myocardial Infarction (MI)
6) Pneumonia Vaccination status for older adults
7) Breast cancer screening
8) Colorectal cancer screening
9) Coronary Artery Disease (CAD): Oral antiplatelet therapy prescribed for patients with CAD
10) Heart Failure (HF): Beta-blocker therapy for Left Ventricular Systolic Dysfunction (LVSD)
11) Anti-depressant medication management:
a) Effective acute phase treatment
b) Effective continuation phase treatment
12) Primary Open Angle Glaucoma (POAG): Optic nerve evaluation
13) Diabetic Retinopathy: Documentation of presence or absence of macular edema and level of security of retinopathy
14) Diabetic Retinopathy: Communication with the physician managing ongoing diabetes care
15) Asthma Pharmacologic Therapy
16) Asthma Assessment
17) Appropriate testing for children with pharyngitis
18) Oncology Breast Cancer: Hormonal therapy for Stage IC-IIIC estrogen receptor/progesterone receptor (ER/PR) positive breast cancer
19) Oncology Breast Cancer: Hormonal therapy for Stage III Colon cancer patients
20) Prostate cancer: Avoidance of overuse of bone scan for staging low risk prostate cancer patients
21) Smoking and Tobacco Use Cessation, Medical assistance:
a) advising smoker and tobacco users to quit
b) discussing smoking and tobacco use cessation medications
c) discussing smoking and tobacco use cessation strategies
22) Diabetes: Eye exam
23) Diabetes: Urine screening
24) Diabetes: Foot exam
25) Coronary Artery Disease (CAD): Drug therapy for lowering LDL-Cholesterol
26) Heart Failure (HF): Warfarin therapy patients with atrial fibrillation
27) Ischemic Vascular Disease (IVD): Blood pressure management
28) Ischemic Vascular Disease (IVD): Use of aspirin or another antithrombotic
29) Initiation and engagement of alcohol and other drug dependence treatment
a) initiation
b) engagement
30) Prenatal care: Screening for Human Immunodeficiency Virus (HIV)
31) Prenatal Care: Anti-D Immune Globulin
32) Controlling High Blood Pressure
33) Cervical Cancer screening
34) Chlamydia screening for women
35) Use of appropriate medications for asthma
36) Low back pain: Use of imaging studies
37) Ischemic Vascular Disease (IVD): Complete lipid panel and LDL control
38) Diabetes: Hemoglobin A1c Control (<8.0%)
These items may be modified in the future as each stage of Meaningful Use requires more of these CQM’s to be met in order to get ARRA funding. However, some of these measures could fail and not make it possible for providers to meet the qualifications. Some patients may have a contraindication to a treatment, and they do not account for those contraindications in these measures. Some patients may not react appropriately to certain treatment approaches and may need a different approach, but those are not accounted for in these measures either. We anticipate exclusions or exceptions for these measures. We expect some changes to the Clinical Quality Measures to come in the next few years as more clinical quality data is gathered and evaluated.
http://www.qualitymeasures.ahrq.gov is another good resource for more information on CQMs.