Quality Measures And Value-Based Payment: What Wound Care Clinicians Should Know

Author(s): 
Caroline E. Fife, MD

   The move toward nationwide transmission of healthcare data took a giant step forward with the passage of the piece of legislation known as the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which President Obama signed into law in February 2009 as part of the economic stimulus bill.

   The Medicare EHR Incentive Program pays up to a $44,000 bonus to each eligible provider who adopts and “meaningfully uses” an electronic medical record. One major component of demonstrating meaningful use is the calculation and reporting of Clinical Quality Measures. Eligible providers must submit three core measures and three additional Clinical Quality Measures from a set of 38. Clinicians can submit three alternate core measures if data are insufficient for the three core measures.

   Let us review these confusing initiatives and how they relate (or don’t relate) to wound care clinicians. Under the HITECH Act, the “meaningful use” of an electronic health record requires a practitioner to submit three Core Clinical Quality Measures or three alternate quality measures plus three “additional measures” for a total of six. If you do this, you are on track for your HITECH bonus money.

   Under PQRS in 2013, there are 265 quality measures, of which you must submit at least three in order to get a 0.5 percent bonus or avoid a 1.5 percent “adjustment.” The CMS worked with the National Quality Forum to retool 113 of the 265 PQRS measures for 2013 into “electronic measures” and of those, CMS selected 51 to be part of the “EHR Direct” program. Given that those 51 EHR measures contain all 44 of the HITECH measures (six core + the 38 menu), you can use the “EHR Direct Pilot” program to meet both the HITECH meaningful use requirements and PQRS. When you submit your measures through EHR Direct, you get your 0.5 percent PQRS bonus, you avoid your 1.5 percent adjustment (the reduction in your total Medicare billing for not reporting), and you have met part of the requirement for your HITECH adoption money.

   Here is the problem for wound care doctors: None of the “EHR measures” are relevant to wound care. There are no electronic measures that relate to wound care.

How Can We Move Forward To Truly Measure Quality In Wound Care?

Wound care practitioners need to consider the types of quality measures by which they would like to be measured. What measures would improve patient outcomes, decrease cost and reflect the quality of care provided? Most of us would agree that the current measures do not do this but the answer to the problem is not to refuse to participate.

   The answer is to work collectively to develop and test better measures. We must begin to act like the specialists we believe we are if we want to continue to care for patients in the face of healthcare reform. The measure development and testing process to meet CMS standards is not a simple process. Wound care organizations and manufacturers need to combine their resources to create and test electronic measures. This will require substantial funding.

   If we begin working now, we might have wound care quality measures ready by 2015 when value-based purchasing is a reality. If we do not create and test wound care quality measures within the next 12 months, the wound care industry may not survive the next decade.

   Dr. Fife recently retired after serving as a Professor of Medicine in the Division of Cardiology and the Director of Clinical Research at the University of Texas Health Science Center in Houston. She is now in the private practice of wound care and hyperbaric medicine in The Woodlands, Texas. Dr. Fife is also the Chief Medical Officer of Intellicure.

References
1. Available at http://www.ama-assn.org/ama/pub/physician-resources/physician-consortium... . Accessed Aug. 10, 2012.
2. Available at http://www.qualitymeasures.ahrq.gov/browse/by-organization-indiv.aspx?ob... . Accessed Aug. 10, 2012.
3. Available at http://www.qualitymeasures.ahrq.gov/content.aspx?id=27944 . Accessed Aug. 10, 2012.

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