CMS Launches Electronic Quality Reporting Pilot For Hospitals

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The Centers for Medicare and Medicaid Services (CMS) has inaugurated an electronic quality reporting pilot for hospitals participating in its Medicare electronic health record (EHR) incentive program.

According to an announcement on CMS's QualityNet site, hospitals and critical access hospitals registered for the Medicare incentive program can begin testing their ability to send quality data directly from their EHRs to CMS. From Oct. 1 to Nov. 30, the last two months in which hospitals can attest to Meaningful Use and receive 2012 payments under the Medicare program, they can transmit this data to CMS on a "production basis" to meet the quality reporting criteria.

If a provider both attests and sends data electronically this year, CMS will use its attestation as the basis for payment, the announcement said.

Next year, hospitals will again be able to attest to Meaningful Use or participate in the electronic reporting pilot. For federal fiscal 2013, however, the facilities in the pilot will have to submit a full year's worth of data. Providers that attest have only a 90-day reporting period if they're in their first year of Meaningful Use, which means they may get paid sooner than they would if they reported electronically.

Robin Raiford, a director in the research and insights division of consulting firm The Advisory Board, told InformationWeek Healthcare that this provision might deter some hospitals from joining the pilot during their first year of Meaningful Use.

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Another difference from the attestation approach is that CMS, not the hospitals, will calculate the numerators and denominators of the clinical quality measures based on the patient-level data submitted by providers.

Before CMS announced its rules for the test last November, the EHR Association (EHRA) protested the patient-level data requirement, saying it would be burdensome on hospitals and expensive for vendors. In the electronic reporting pilot, the data must be transmitted using a new transport standard called the Quality Reporting Data Architecture (QRDA). Vendors would have to rewrite their software to allow the quality data to be sent to CMS in this format, noted EHRA.

In response to a question from InformationWeek Healthcare, EHRA spokeswoman Elizabeth West said the organization had not surveyed its members to find out how many have adopted the QDRA standard. However, she pointed out that vendors that are allowed to submit quality data to CMS's Physician Quality Reporting System (PQRS) on behalf of physicians use QDRA, as do makers of ambulatory care EHRs that doctors can use to submit PRQS data directly.

Among these vendors, the only ones that also sell hospital systems are Allscripts, Cerner, and Epic.

To make participation in the pilot seem more attractive, CMS observed that it might hasten the day when hospitals will be able to collect and report quality data just once, not only for the EHR incentive program, but also for CMS's Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) programs.

However, Raiford pointed out that reporting on clinical quality measures is one of the biggest challenges that hospitals encounter in showing Meaningful Use. "There are 160-odd pieces of data for those 15 quality measures," she said, and not all of them are easy to produce in most EHRs. Also, some of the requisite data may come from other systems, such as surgical or emergency room software, that are not part of the inpatient system. And clinicians don't always document everything when it happens. Consequently, when hospitals assemble quality data for attestation to Meaningful Use, they often do it by pulling data retrospectively.

In contrast, being able to transmit patient-level data to CMS means "actually capturing it in real time," she said. "So in the beginning, it increases the burden on the facility to make sure the data is collected upfront, not by retrospective review."

As mentioned earlier, physicians already are allowed to submit data electronically to CMS's Physician Quality Reporting System by using a qualified EHR or going through a qualified EHR data submission vendor. Eligible professionals who choose to participate in the PQRS-Medicare EHR Incentive Pilot--which is separate from the hospital test--get credit for reporting clinical quality data for the purpose of showing Meaningful Use. They must submit their data for the full calendar year 2012 by Feb. 28, 2013.